Healthcare Provider Details

I. General information

NPI: 1467188854
Provider Name (Legal Business Name): DOS RIOS WELLNESS & DAY SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 AUGUSTA DR SE
RIO RANCHO NM
87124-8246
US

IV. Provider business mailing address

3916 AUGUSTA DR SE
RIO RANCHO NM
87124-8246
US

V. Phone/Fax

Practice location:
  • Phone: 505-903-9510
  • Fax:
Mailing address:
  • Phone: 505-903-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STACEY DEMAREY
Title or Position: CORPORATE OFFICER
Credential: LCSW
Phone: 505-903-9510