MEDICARE: NORTH VALLEY ACUPUNCTURE AND FAMILY PRACTICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	1050	NM

General Provider Information

NPI Number	:	1093095176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH VALLEY ACUPUNCTURE AND FAMILY PRACTICE, LLC

Provider Business Mailing Address
First Line	:	7120 4TH ST NW
Second Line	:	STE. A
City	:	LOS RANCHOS
State	:	NM
Zip	:	87107-6642
Country	:	US
Telephone Number	:	505-899-7095
Fax Number	:	505-792-4085

Provider Business Practice Location Address
First Line	:	7120 4TH ST NW
Second Line	:	STE. A
City	:	LOS RANCHOS
State	:	NM
Zip	:	87107-6642
Country	:	US
Telephone Number	:	505-899-7095
Fax Number	:	505-792-4085

Authorized Official
Title or Position	:	DOCTOR OF ORIENTAL MEDICINE/OWNER
Name	:	RUTH MICHELLE MATKIN
Credential	:	RN, DOM
Telephone Number	:	505-899-7095

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	08/22/2011

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