Healthcare Provider Details

I. General information

NPI: 1508482316
Provider Name (Legal Business Name): WELLNESS AND AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N ALAMEDA BLVD
LAS CRUCES NM
88005-2128
US

IV. Provider business mailing address

705 N ALAMEDA BLVD
LAS CRUCES NM
88005-2128
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1336
  • Fax: 323-334-1449
Mailing address:
  • Phone: 575-288-1336
  • Fax: 323-334-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE CASTILLO
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 575-288-1336