=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730287962
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACUPUNCTURE ASSOCIATES OF AMERICA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2901 JUAN TABO BLVD NE STE 117
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-1885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-275-9602
-----------------------------------------------------
Fax | 505-275-9604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 JUAN TABO BLVD NE STE 117
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-1885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-275-9602
-----------------------------------------------------
Fax | 505-275-9604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LORELLA D. TAPIA-REYES
-----------------------------------------------------
Credential | D.O.M.
-----------------------------------------------------
Telephone | 505-275-9602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 722RX1
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------