Healthcare Provider Details

I. General information

NPI: 1487918801
Provider Name (Legal Business Name): FITNESS PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 CALLE DEL CIELO
SANTA FE NM
87507-5075
US

IV. Provider business mailing address

1119 CALLE DEL CIELO
SANTA FE NM
87507-5075
US

V. Phone/Fax

Practice location:
  • Phone: 505-473-7315
  • Fax: 505-471-1824
Mailing address:
  • Phone: 505-473-7315
  • Fax: 505-471-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number0005
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number0018
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number177
License Number StateNM

VIII. Authorized Official

Name: DR. JOSEPH OLIARO
Title or Position: PROVIDER
Credential: D.O.M. D.N.
Phone: 505-473-7315