Provider Demographics
NPI:1659605368
Name:PUBLIC HEALTH ACUPUNCTURE OF NEW MEXICO
Entity Type:Organization
Organization Name:PUBLIC HEALTH ACUPUNCTURE OF NEW MEXICO
Other - Org Name:FIVE NP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NITYAMO
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, MPH
Authorized Official - Phone:505-232-7654
Mailing Address - Street 1:PO BOX 35863
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-5863
Mailing Address - Country:US
Mailing Address - Phone:505-232-7654
Mailing Address - Fax:
Practice Address - Street 1:1317 PRINCETON DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2618
Practice Address - Country:US
Practice Address - Phone:505-232-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMVARIOUS101YA0400X, 171100000X, 174400000X
NM608171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty