Healthcare Provider Details

I. General information

NPI: 1649499534
Provider Name (Legal Business Name): NAPRAPATHIC MEDICINE OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CERRILLOS RD SUITE 407
SANTA FE NM
87507-2612
US

IV. Provider business mailing address

3600 CERRILLOS RD SUITE 407
SANTA FE NM
87507-2612
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-8990
  • Fax: 505-424-6377
Mailing address:
  • Phone: 505-424-8990
  • Fax: 505-424-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number0003
License Number StateNM

VIII. Authorized Official

Name: DR. KIRSTEN LAVISTA
Title or Position: DOCTOR OF NAPRAPATHY
Credential: DN
Phone: 505-424-8990