Healthcare Provider Details

I. General information

NPI: 1700117090
Provider Name (Legal Business Name): BLUE LOTUS HEALTH ESSENTIALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PASEO DE PERALTA STE A
SANTA FE NM
87501-1984
US

IV. Provider business mailing address

618 PASEO DE PERALTA STE A
SANTA FE NM
87501-1984
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-9109
  • Fax: 505-989-3221
Mailing address:
  • Phone: 505-986-9109
  • Fax: 505-989-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number3027
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number634
License Number StateNM

VIII. Authorized Official

Name: MS. KERRILYN CHEW
Title or Position: DIRECTOR/INCORPORATOR
Credential: DOM
Phone: 505-986-9109