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General NPI Number Information
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NPI Number | 1689907388
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Entity Type | Organization
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Legal Business Name | AMRITA ACUPUNCTURE & HERBOLOGY
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Dates
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Enumeration Date | 09/12/2009
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Last Update Date | 09/12/2009
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Provider Practice Location Address
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Address Line | 219 N 4TH ST
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City | BELEN
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State | NM
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Zip | 87002-4315
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Country | US
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Telephone | 505-861-0332
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Fax | 505-861-0332
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Provider Business Mailing Address
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Address Line | 219 N 4TH ST
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City | BELEN
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State | NM
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Zip | 87002-4315
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Country | US
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Telephone | 505-861-0332
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Fax | 505-861-0332
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Authorized Official
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Title or Position | OWNER
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Name | SUZANNE L BARRY
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Credential | DOM
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Telephone | 505-861-0332
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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 | 497RX2
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License Number State | NM
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