Healthcare Provider Details

I. General information

NPI: 1730728478
Provider Name (Legal Business Name): EYNDIA OMEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2019
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6587 VALENTINE WAY UNIT 607
SANTA FE NM
87507-2491
US

IV. Provider business mailing address

6587 VALENTINE WAY
SANTA FE NM
87507-3173
US

V. Phone/Fax

Practice location:
  • Phone: 480-205-3892
  • Fax:
Mailing address:
  • Phone: 480-205-3892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number22006R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: