MEDICARE: MS. KATHLEEN J MATHEWS DOM

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	835	NM

General Provider Information

NPI Number	:	1548483688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN J MATHEWS DOM

Provider Business Mailing Address
First Line	:	400 GOLD AVE SW
Second Line	:	SUITE 1060
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3283
Country	:	US
Telephone Number	:	505-848-7828
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 GOLD AVE SW
Second Line	:	SUITE 1060
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3283
Country	:	US
Telephone Number	:	505-848-7828
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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