Healthcare Provider Details

I. General information

NPI: 1245495266
Provider Name (Legal Business Name): FULL CIRCLE WELLNES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1718
US

IV. Provider business mailing address

1719 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1718
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-3400
  • Fax:
Mailing address:
  • Phone: 505-265-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ELIZABETH HERNANDEZ
Title or Position: VP
Credential:
Phone: 505-265-3400