Healthcare Provider Details

I. General information

NPI: 1871627224
Provider Name (Legal Business Name): JEROME DEUTSCH MS, LN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 F CALLE OJO FELIZ
SANTA FE NM
87505
US

IV. Provider business mailing address

147 F CALLE OJO FELIZ
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-0922
  • Fax: 505-954-4234
Mailing address:
  • Phone: 505-955-0922
  • Fax: 505-954-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number538
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: