Healthcare Provider Details

I. General information

NPI: 1114796893
Provider Name (Legal Business Name): LOTUS WELLNESS & WEIGHT LOSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN ST
BELEN NM
87002-3716
US

IV. Provider business mailing address

320 N MAIN ST
BELEN NM
87002-3716
US

V. Phone/Fax

Practice location:
  • Phone: 505-361-1167
  • Fax: 505-361-1167
Mailing address:
  • Phone: 505-361-1167
  • Fax: 505-361-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY S LOPEZ
Title or Position: OWNER
Credential: FNP-C
Phone: 623-910-2777