Healthcare Provider Details

I. General information

NPI: 1770236515
Provider Name (Legal Business Name): MIMO HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MORRIS ST NE STE B
ALBUQUERQUE NM
87111-3605
US

IV. Provider business mailing address

4101 MORRIS ST NE STE B
ALBUQUERQUE NM
87111-3605
US

V. Phone/Fax

Practice location:
  • Phone: 505-615-7972
  • Fax: 866-835-8369
Mailing address:
  • Phone: 505-615-7972
  • Fax: 866-835-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HOPKINS
Title or Position: MANAGER
Credential: MD
Phone: 505-235-2987