Healthcare Provider Details

I. General information

NPI: 1871624577
Provider Name (Legal Business Name): ALLISON LINLEY HOWARD DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/01/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 4TH ST
SANTA FE NM
87505-3426
US

IV. Provider business mailing address

204 W LUPITA RD
SANTA FE NM
87505-4720
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-2500
  • Fax:
Mailing address:
  • Phone: 575-520-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 7336
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDOM1248
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: