Healthcare Provider Details

I. General information

NPI: 1710876719
Provider Name (Legal Business Name): ABQ WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LOUISIANA BLVD NE STE A2
ALBUQUERQUE NM
87110-3550
US

IV. Provider business mailing address

2900 LOUISIANA BLVD NE STE A2
ALBUQUERQUE NM
87110-3550
US

V. Phone/Fax

Practice location:
  • Phone: 505-999-0470
  • Fax:
Mailing address:
  • Phone: 505-999-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MESTAS
Title or Position: PARTNER
Credential: NP
Phone: 505-999-0470