Provider Demographics
NPI:1053618215
Name:KANTER, REBEKAH (DOM)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:KANTER
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 1:1925 ASPEN DR STE 803B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5578
Mailing Address - Country:US
Mailing Address - Phone:352-636-9638
Mailing Address - Fax:
Practice Address - Street 1:369 MONTEZUMA AVE # 531
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2835
Practice Address - Country:US
Practice Address - Phone:352-636-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM998171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist