Provider Demographics
NPI:1720297468
Name:ALDERETTE ACUPUNCTURE AND HERBAL MEDICINE
Entity Type:Organization
Organization Name:ALDERETTE ACUPUNCTURE AND HERBAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:MAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-445-1037
Mailing Address - Street 1:210 COOK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-3959
Mailing Address - Country:US
Mailing Address - Phone:505-445-1037
Mailing Address - Fax:505-445-1041
Practice Address - Street 1:210 COOK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-3959
Practice Address - Country:US
Practice Address - Phone:505-445-1037
Practice Address - Fax:505-445-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty