Healthcare Provider Details

I. General information

NPI: 1275373250
Provider Name (Legal Business Name): WFA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE STE 4
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

1005 21ST ST SE
RIO RANCHO NM
87124-4030
US

V. Phone/Fax

Practice location:
  • Phone: 505-589-9595
  • Fax:
Mailing address:
  • Phone: 505-589-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOVANNA MALDONADO
Title or Position: CEO
Credential: LMT
Phone: 505-589-5959