Healthcare Provider Details

I. General information

NPI: 1821978289
Provider Name (Legal Business Name): VITALITY HEALTH AND WELLNESS CLINIC INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 MAIN ST SW
LOS LUNAS NM
87031-8308
US

IV. Provider business mailing address

705 MAIN ST SW
LOS LUNAS NM
87031-8308
US

V. Phone/Fax

Practice location:
  • Phone: 505-808-1866
  • Fax:
Mailing address:
  • Phone: 505-808-1866
  • Fax: 505-808-6966

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: JAHNELLE GARCIA
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 505-239-9146