Healthcare Provider Details

I. General information

NPI: 1811000896
Provider Name (Legal Business Name): YUKO CROSSWHITE D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 LUISA ST STE J
SANTA FE NM
87505-4073
US

IV. Provider business mailing address

2105 PASEO PONDEROSA
SANTA FE NM
87501-8390
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-2461
  • Fax:
Mailing address:
  • Phone: 505-820-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number847
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: