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General NPI Number Information
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NPI Number | 1134493232
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT AND SPECIAL CARE MEDICINE
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 6800 MONTGOMERY BLVD NE SUITE E
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1405
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Country | US
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Telephone | 505-883-9598
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Fax | 505-883-4563
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Provider Business Mailing Address
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Address Line | 6800 MONTGOMERY BLVD NE SUITE E
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1405
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Country | US
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Telephone | 505-883-9598
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Fax | 505-883-4563
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERESA IVONNE BELFON
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Credential | DOM
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Telephone | 505-883-9598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 967
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License Number State | NM
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