Provider Demographics
NPI:1023267002
Name:RED PHOENIX ACUPUNCTURE LLC
Entity type:Organization
Organization Name:RED PHOENIX ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-896-6965
Mailing Address - Street 1:4041 BARBARA LOOP SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1065
Mailing Address - Country:US
Mailing Address - Phone:505-896-6965
Mailing Address - Fax:
Practice Address - Street 1:4041 BARBARA LOOP SE
Practice Address - Street 2:SUITE A
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1065
Practice Address - Country:US
Practice Address - Phone:505-896-6965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM906171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty