Provider Demographics
NPI:1720109101
Name:ACUPUNCTURE CENTER OF LOS ALAMOS
Entity Type:Organization
Organization Name:ACUPUNCTURE CENTER OF LOS ALAMOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-663-1339
Mailing Address - Street 1:2610 TRINITY DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2376
Mailing Address - Country:US
Mailing Address - Phone:505-663-1339
Mailing Address - Fax:505-662-7371
Practice Address - Street 1:2610 TRINITY DR
Practice Address - Street 2:SUITE 14
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2376
Practice Address - Country:US
Practice Address - Phone:505-663-1339
Practice Address - Fax:505-662-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM534171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty