Healthcare Provider Details

I. General information

NPI: 1780358911
Provider Name (Legal Business Name): KAREN CARMONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 PLACITA LOMA
SANTA FE NM
87501-1594
US

IV. Provider business mailing address

1022 PLACITA LOMA
SANTA FE NM
87501-1594
US

V. Phone/Fax

Practice location:
  • Phone: 818-857-9857
  • Fax:
Mailing address:
  • Phone: 818-857-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1229
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: