Healthcare Provider Details

I. General information

NPI: 1629291398
Provider Name (Legal Business Name): CAROL RAGLE DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 N PINOS ALTOS RD
SILVER CITY NM
88061-7865
US

IV. Provider business mailing address

2258 N PINOS ALTOS RD
SILVER CITY NM
88061-7865
US

V. Phone/Fax

Practice location:
  • Phone: 505-538-0559
  • Fax:
Mailing address:
  • Phone: 505-538-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number342
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: