Healthcare Provider Details

I. General information

NPI: 1619805017
Provider Name (Legal Business Name): CATHERINE MAXWELL DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 SAINT MICHAELS DR
SANTA FE NM
87505-7712
US

IV. Provider business mailing address

3163 PLAZA BLANCA
SANTA FE NM
87507-5343
US

V. Phone/Fax

Practice location:
  • Phone: 505-633-4192
  • Fax:
Mailing address:
  • Phone: 505-633-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAOM-2023-0014
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: