Healthcare Provider Details

I. General information

NPI: 1487014957
Provider Name (Legal Business Name): SOUL HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 BRUNN SCHOOL RD STE C
SANTA FE NM
87505-1102
US

IV. Provider business mailing address

PO BOX 28339
SANTA FE NM
87592-8339
US

V. Phone/Fax

Practice location:
  • Phone: 505-718-8673
  • Fax:
Mailing address:
  • Phone: 505-718-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIGI DULANTO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 505-718-8673