Healthcare Provider Details

I. General information

NPI: 1295880292
Provider Name (Legal Business Name): LEAH FINEBERG D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W DE VARGAS ST SUITE 5
SANTA FE NM
87501-2643
US

IV. Provider business mailing address

4012 OLD SANTA FE TRL
SANTA FE NM
87505-4500
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-5387
  • Fax:
Mailing address:
  • Phone: 505-983-5387
  • Fax: 505-986-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number132
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: