Healthcare Provider Details

I. General information

NPI: 1609040807
Provider Name (Legal Business Name): JOANNA CORTI DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W SAN FRANCISCO ST
SANTA FE NM
87501-1941
US

IV. Provider business mailing address

439 W SAN FRANCISCO ST
SANTA FE NM
87501-1941
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-1460
  • Fax: 505-424-7878
Mailing address:
  • Phone: 505-989-1460
  • Fax: 505-424-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number329
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: