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General NPI Number Information
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NPI Number | 1801332325
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Entity Type | Organization
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Legal Business Name | RED ROOT ACUPUNCTURE & HERBS
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Dates
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Enumeration Date | 01/07/2017
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 2400 RIO GRANDE BLVD NW STE E
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-3240
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Country | US
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Telephone | 505-242-2032
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 RIO GRANDE BLVD NW STE E
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-3240
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNERACUPUNCTURIST
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Name | MISS MONICA NICOLE LUCERO
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Credential | DOM
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Telephone | 505-550-5358
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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 | 1134
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1126
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License Number State | NM
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