Healthcare Provider Details

I. General information

NPI: 1326272436
Provider Name (Legal Business Name): ALYIAH DOUGHTY D.O.M., L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 CAMINO DE CHELLY
SANTA FE NM
87505-6264
US

IV. Provider business mailing address

P.O. BOX 5514
SANTA FE NM
87502-5514
US

V. Phone/Fax

Practice location:
  • Phone: 505-501-5095
  • Fax:
Mailing address:
  • Phone: 505-501-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number229
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number494
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: