Healthcare Provider Details

I. General information

NPI: 1396675435
Provider Name (Legal Business Name): ORGAN PEAK WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 GARRISON RD
LAS CRUCES NM
88001-5706
US

IV. Provider business mailing address

2130 GARRISON RD
LAS CRUCES NM
88001-5706
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-4059
  • Fax:
Mailing address:
  • Phone: 575-915-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: XAN ASMODEUS GARZA
Title or Position: COMMUNITY HEALTH WORKER
Credential: CCHW S2
Phone: 575-915-4059