Healthcare Provider Details

I. General information

NPI: 1912347931
Provider Name (Legal Business Name): AMANDA CATHERINE ARCHULETA DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 CALLE PRINCESA JUANA
SANTA FE NM
87507-5032
US

IV. Provider business mailing address

3003 CALLE PRINCESA JUANA
SANTA FE NM
87507-5032
US

V. Phone/Fax

Practice location:
  • Phone: 505-501-2777
  • Fax:
Mailing address:
  • Phone: 505-501-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1115
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: