Healthcare Provider Details

I. General information

NPI: 1437551173
Provider Name (Legal Business Name): HIGH DESERT HEALTHCARE & MASSAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 PASEO DE PERALTA
SANTA FE NM
87501-1955
US

IV. Provider business mailing address

644 PASEO DE PERALTA
SANTA FE NM
87501-1955
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-8830
  • Fax:
Mailing address:
  • Phone: 505-984-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JILL GERBER
Title or Position: OWNER
Credential:
Phone: 505-984-8830