Healthcare Provider Details

I. General information

NPI: 1770590978
Provider Name (Legal Business Name): ROBYN BENSON DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 RODEO PARK DR E BLDG 3
SANTA FE NM
87505-6313
US

IV. Provider business mailing address

18 PIUTE RD.
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-1089
  • Fax: 505-986-0194
Mailing address:
  • Phone: 505-986-1089
  • Fax: 505-986-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number274RX2
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: