Healthcare Provider Details

I. General information

NPI: 1679422547
Provider Name (Legal Business Name): MOLLY DAVIDSON
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: MOLLY HOLMBO

II. Dates (important events)

Enumeration Date: 01/24/2026
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PASEO DE PERALTA
SANTA FE NM
87501-1860
US

IV. Provider business mailing address

5 PINON RIDGE RD
PECOS NM
87552-2544
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDOM1290
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: