Healthcare Provider Details

I. General information

NPI: 1316287527
Provider Name (Legal Business Name): DAVID JOHN MONEY DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALIENTE RD SUITE 1
SANTA FE NM
87508-9100
US

IV. Provider business mailing address

5 CALIENTE RD SUITE 1
SANTA FE NM
87508-9100
US

V. Phone/Fax

Practice location:
  • Phone: 505-288-1711
  • Fax:
Mailing address:
  • Phone: 505-288-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1095
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: