Healthcare Provider Details

I. General information

NPI: 1760934269
Provider Name (Legal Business Name): EVA WHEELER-SAGIAO LMT & CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 WADE BLVD
CLOVIS NM
88101-9511
US

IV. Provider business mailing address

2800 WADE BLVD
CLOVIS NM
88101-9511
US

V. Phone/Fax

Practice location:
  • Phone: 808-343-0123
  • Fax:
Mailing address:
  • Phone: 808-343-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8434
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14180
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: