Healthcare Provider Details

I. General information

NPI: 1366227969
Provider Name (Legal Business Name): ARIELA SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 VALLEJOS LN E
LOS LUNAS NM
87031
US

IV. Provider business mailing address

16559D HIGHWAY 60
BOSQUE NM
87006-9719
US

V. Phone/Fax

Practice location:
  • Phone: 505-420-7073
  • Fax:
Mailing address:
  • Phone: 505-420-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22024
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: