Healthcare Provider Details

I. General information

NPI: 1871508556
Provider Name (Legal Business Name): DHARAMPAL KHALSA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
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

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

V. Phone/Fax

Practice location:
  • Phone: 505-946-7951
  • Fax:
Mailing address:
  • Phone: 505-946-7610
  • Fax: 505-303-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberA-1961-16
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: