Healthcare Provider Details

I. General information

NPI: 1689177156
Provider Name (Legal Business Name): NEW MEXICO NATURAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 OLD AGUA FRIA RD E
SANTA FE NM
87508-5970
US

IV. Provider business mailing address

PO BOX 8239
SANTA FE NM
87504-8239
US

V. Phone/Fax

Practice location:
  • Phone: 505-629-6676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNM

VIII. Authorized Official

Name: KELLY FRITH
Title or Position: SOLE MEMBER OWNER
Credential:
Phone: 505-629-6676