Healthcare Provider Details

I. General information

NPI: 1790622736
Provider Name (Legal Business Name): KOKOPELLI TRADITIONAL CHINESE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 ROSINA ST STE 5
SANTA FE NM
87505-3284
US

IV. Provider business mailing address

6332 ENTRADA DE MILAGRO APT 1224
SANTA FE NM
87507-1654
US

V. Phone/Fax

Practice location:
  • Phone: 505-519-6804
  • Fax:
Mailing address:
  • Phone: 505-519-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: LUIS LORENZO RAMIREZ
Title or Position: OWNER /PRACTITIONER
Credential: D.O.M
Phone: 505-519-6804