Healthcare Provider Details

I. General information

NPI: 1396386892
Provider Name (Legal Business Name): SOUTHWEST CENTER FOR OSTEOPATHIC MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 10/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 S SAINT FRANCIS DR STE C
SANTA FE NM
87505-4098
US

IV. Provider business mailing address

4218 CYMBELINE CT
LAS CRUCES NM
88011-8027
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-7951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DHARAMPAL SINGH KHALSA
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 505-927-3408