Provider Demographics
NPI:1508928532
Name:RAEL, JANE (DOM)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:RAEL
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 1:1512 RIO GRANDE BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6130
Mailing Address - Country:US
Mailing Address - Phone:505-565-4325
Mailing Address - Fax:505-866-0639
Practice Address - Street 1:19499 HWY 314
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002
Practice Address - Country:US
Practice Address - Phone:505-565-4325
Practice Address - Fax:505-866-0639
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM603171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2122627OtherUNITED HEALTH CARE
NMR93EOtherBLUE CROSS BLUE SHIELD OF