Provider Demographics
NPI:1730918939
Name:RAINE, NAOMI R (DOM)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:R
Last Name:RAINE
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 1:3901 GEORGIA ST NE STE E3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1388
Mailing Address - Country:US
Mailing Address - Phone:505-585-9190
Mailing Address - Fax:
Practice Address - Street 1:3901 GEORGIA ST NE STE E3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1388
Practice Address - Country:US
Practice Address - Phone:505-585-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDOM1285171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty