Basic Information
| Provider Information | |||||||||
| NPI: | 1447216254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1279 SENDA DEL VALLE | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875077181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054382646 | ||||||||
| FaxNumber: | 5059866005 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 N GUADALUPE ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875011827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059884357 | ||||||||
| FaxNumber: | 5059866005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 883 | NM | Y | Other Service Providers | Acupuncturist |
No ID Information.