Healthcare Provider Details

I. General information

NPI: 1821461948
Provider Name (Legal Business Name): DIANA HERRERA D.O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2538 CAMINO ENTRADA STE 300
SANTA FE NM
87507-4927
US

IV. Provider business mailing address

2538 CAMINO ENTRADA STE 300
SANTA FE NM
87507-4927
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-1239
  • Fax: 888-746-4761
Mailing address:
  • Phone: 505-424-1239
  • Fax: 888-746-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number171100000X
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number260708446
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: