Healthcare Provider Details

I. General information

NPI: 1154948081
Provider Name (Legal Business Name): DESIGNED HEALTH OPTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5065 CORRALES RD.
CORRALES NM
87048
US

IV. Provider business mailing address

PO BOX 2480
CORRALES NM
87048-2480
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-8154
  • Fax: 505-919-7061
Mailing address:
  • Phone: 505-404-8154
  • Fax: 505-919-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOAN LEWIS
Title or Position: CEO/OWNER
Credential: MD
Phone: 505-919-7061