Provider Demographics
NPI:1740368299
Name:CICERI, CHRISTINE ARMELL (DOM)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ARMELL
Last Name:CICERI
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 1:224 CRUZ ALTA RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5947
Mailing Address - Country:US
Mailing Address - Phone:505-751-1616
Mailing Address - Fax:
Practice Address - Street 1:224 CRUZ ALTA RD
Practice Address - Street 2:SUITE G
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5947
Practice Address - Country:US
Practice Address - Phone:505-751-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM262171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist