MEDICARE: DR. JONATHAN GIMBEL D.O.M.

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	1088	NM

General Provider Information

NPI Number	:	1447381025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN GIMBEL D.O.M.

Provider Business Mailing Address
First Line	:	1642 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7712
Country	:	US
Telephone Number	:	505-670-6891
Fax Number	:	505-633-4192

Provider Business Practice Location Address
First Line	:	1642 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7712
Country	:	US
Telephone Number	:	505-670-6891
Fax Number	:	505-633-4192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	06/26/2020

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