Healthcare Provider Details

I. General information

NPI: 1285761197
Provider Name (Legal Business Name): EMILY MAIA FRANKLIN DOM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 S SAINT FRANCIS DR
SANTA FE NM
87505-4039
US

IV. Provider business mailing address

1547 S SAINT FRANCIS DR
SANTA FE NM
87505-4039
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-1860
  • Fax: 505-820-1860
Mailing address:
  • Phone: 505-820-1860
  • Fax: 505-820-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number839
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: