| Organization Name: | SOUTHWEST CENTER FOR INTEGRATIVE MEDICINE |
| NPI Number: | 1497026405 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOMINIC STAPE (C.E.O./ OWNER) |
| Mailing Address: | 1012 Eubank Blvd Ne Albuquerque |
| State: | NM US |
| Postal Code: | 871125310 |
| Phone Number: | 5052984325 |
| Fax Number: | 5052945407 |
| NPI Enumeration Date: | 01/23/2012 |
| NPI Last Update Date: | 05/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | BB7316436 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |