Healthcare Provider Details

I. General information

NPI: 1184456071
Provider Name (Legal Business Name): ARI WUNDERLICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 E AMADOR AVE STE 101
LAS CRUCES NM
88001-3675
US

IV. Provider business mailing address

3621 MARION LN
LAS CRUCES NM
88012-7579
US

V. Phone/Fax

Practice location:
  • Phone: 91-560-3079
  • Fax:
Mailing address:
  • Phone: 915-603-0794
  • Fax: 505-929-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: