Healthcare Provider Details

I. General information

NPI: 1639533516
Provider Name (Legal Business Name): SOL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 2ND ST SUITE 44C
SANTA FE NM
87505-3499
US

IV. Provider business mailing address

PO BOX 22383
SANTA FE NM
87502-2383
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-1119
  • Fax: 505-349-4748
Mailing address:
  • Phone: 505-216-1119
  • Fax: 505-349-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCNP-02467
License Number StateNM

VIII. Authorized Official

Name: DR. JULIE D GRACE
Title or Position: OWNER
Credential: DN
Phone: 505-216-1119