Organization
KOKOPELLI EAST WEST INTEGRATED FAMILY HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES DALKYU PARK PT, DOM (MANAGING OFFICER)
(505) 514-2900
Entity
Organization
Contact information
Practice address
2808 MESA RD SE, RIO RANCHO, NM 87124-7229
(505) 994-0669
Mailing address
5900 FOREST HILLS DR NE, ALBUQUERQUE, NM 87109-4129
(505) 514-2900
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2033
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1929182795
GROUP NPI
NM
Enumeration date
04/25/2007
Last updated
08/22/2020
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