Healthcare Provider Details

I. General information

NPI: 1932917218
Provider Name (Legal Business Name): BHAKTI HEART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 CAMINO LA CANADA
SANTA FE NM
87501-5804
US

IV. Provider business mailing address

1834 CAMINO LA CANADA
SANTA FE NM
87501-5804
US

V. Phone/Fax

Practice location:
  • Phone: 575-405-2337
  • Fax:
Mailing address:
  • Phone: 575-405-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: SUSAN C MCGONNELL
Title or Position: PROGRAM MANAGER
Credential:
Phone: 575-405-2337