Provider Demographics
NPI:1053505792
Name:GRD ACUPUNCTURE LLC
Entity type:Organization
Organization Name:GRD ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATWANT
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-753-3369
Mailing Address - Street 1:415 N PASEO DE ONATE
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2619
Mailing Address - Country:US
Mailing Address - Phone:505-753-3369
Mailing Address - Fax:505-753-4006
Practice Address - Street 1:415 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2619
Practice Address - Country:US
Practice Address - Phone:505-753-3369
Practice Address - Fax:505-753-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty