Provider Demographics
NPI:1548483688
Name:MATHEWS, KATHLEEN J (DOM)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:J
Last Name:MATHEWS
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 1:400 GOLD AVE SW
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3283
Mailing Address - Country:US
Mailing Address - Phone:505-848-7828
Mailing Address - Fax:
Practice Address - Street 1:400 GOLD AVE SW
Practice Address - Street 2:SUITE 1060
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3283
Practice Address - Country:US
Practice Address - Phone:505-848-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM835171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist