Healthcare Provider Details

I. General information

NPI: 1619704202
Provider Name (Legal Business Name): EPITOME OF YOUTH WELLNESS & AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S CANYON ST
CARLSBAD NM
88220-5734
US

IV. Provider business mailing address

605 E CHAPMAN RD
CARLSBAD NM
88220-9388
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5151
  • Fax:
Mailing address:
  • Phone: 702-280-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMBER BOJORQUEZ
Title or Position: OWNER
Credential: CNP
Phone: 702-280-2458