Healthcare Provider Details

I. General information

NPI: 1508525486
Provider Name (Legal Business Name): VOLCANO VISTA PSYCHIATRY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JUNIPER RD
PLACITAS NM
87043-9123
US

IV. Provider business mailing address

PO BOX 561
PLACITAS NM
87043-0561
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-9364
  • Fax:
Mailing address:
  • Phone: 505-404-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ESTHER DENISE VERZI
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: CNP, DNP, PMHNP-BC
Phone: 505-404-9364