Basic Information
| Provider Information | |||||||||
| NPI: | 1013148840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DOM, LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1348 PACHECO ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059882449 | ||||||||
| FaxNumber: | 5059866005 | ||||||||
| Practice Location | |||||||||
| Address1: | 1348 PACHECO ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059882449 | ||||||||
| FaxNumber: | 5059866005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2009 | ||||||||
| LastUpdateDate: | 05/31/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 999 | NM | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Acupuncturist | 225700000X | 3765 | NM | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.