Healthcare Provider Details

I. General information

NPI: 1689074460
Provider Name (Legal Business Name): SALUBRIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3538 ANDERSON AVE SE
ALBUQUERQUE NM
87106-1612
US

IV. Provider business mailing address

3538 ANDERSON AVE SE
ALBUQUERQUE NM
87106-1612
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-4325
  • Fax:
Mailing address:
  • Phone: 505-573-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number867RX2
License Number StateNM

VIII. Authorized Official

Name: DR. KARLA KOCH
Title or Position: OWNER
Credential: ND, DOM, RN
Phone: 505-573-4325