Provider Demographics
NPI:1093095176
Name:NORTH VALLEY ACUPUNCTURE AND FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:NORTH VALLEY ACUPUNCTURE AND FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDICINE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, DOM
Authorized Official - Phone:505-899-7095
Mailing Address - Street 1:7120 4TH ST NW
Mailing Address - Street 2:STE. A
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6642
Mailing Address - Country:US
Mailing Address - Phone:505-899-7095
Mailing Address - Fax:505-792-4085
Practice Address - Street 1:7120 4TH ST NW
Practice Address - Street 2:STE. A
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6642
Practice Address - Country:US
Practice Address - Phone:505-899-7095
Practice Address - Fax:505-792-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty