Healthcare Provider Details

I. General information

NPI: 1003441015
Provider Name (Legal Business Name): SOLAMENTE HOLISTIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 LOMAS BLVD NW
ALBUQUERQUE NM
87102-1955
US

IV. Provider business mailing address

833 LOMAS BLVD NW
ALBUQUERQUE NM
87102-1955
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-6353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELISHAROSE TRUJILLO
Title or Position: MEMBER
Credential:
Phone: 505-243-6353