Healthcare Provider Details

I. General information

NPI: 1235054354
Provider Name (Legal Business Name): AWAKENING OASIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 QUANTUM RD NE STE 6
RIO RANCHO NM
87124-4505
US

IV. Provider business mailing address

7615 PRAIRIE FALCON AVE NW
ALBUQUERQUE NM
87114-4435
US

V. Phone/Fax

Practice location:
  • Phone: 915-262-3930
  • Fax:
Mailing address:
  • Phone: 915-262-3930
  • 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: DESIREE FERNANDEZ
Title or Position: CEO
Credential: LMT
Phone: 915-262-3930