Healthcare Provider Details

I. General information

NPI: 1174303580
Provider Name (Legal Business Name): REBECCA L WELLING DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W ZIA RD
SANTA FE NM
87505-5750
US

IV. Provider business mailing address

113 W ZIA RD
SANTA FE NM
87505-5750
US

V. Phone/Fax

Practice location:
  • Phone: 505-670-8045
  • Fax:
Mailing address:
  • Phone: 505-670-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDOM969
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: