Healthcare Provider Details

I. General information

NPI: 1437067477
Provider Name (Legal Business Name): SANTA FE SPINE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 E LA ENTRADA
CORRALES NM
87048-7647
US

IV. Provider business mailing address

353 E LA ENTRADA
CORRALES NM
87048-7647
US

V. Phone/Fax

Practice location:
  • Phone: 267-808-3189
  • Fax:
Mailing address:
  • Phone: 267-808-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN AVERNA
Title or Position: OWNER / PHYSICIAN
Credential: DO
Phone: 267-808-3189