Provider Demographics
NPI:1114530383
Name:SCHOEN, TRAVIS ROBIN (DOM)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ROBIN
Last Name:SCHOEN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CALLE VARADA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7625
Mailing Address - Country:US
Mailing Address - Phone:575-613-0398
Mailing Address - Fax:
Practice Address - Street 1:460 SAINT MICHAELS DR STE 1205
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-8605
Practice Address - Country:US
Practice Address - Phone:505-490-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDOM1264171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist