Healthcare Provider Details

I. General information

NPI: 1093964546
Provider Name (Legal Business Name): A WELL FOR HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 BISHOPS LODGE RD
SANTA FE NM
87506-0005
US

IV. Provider business mailing address

1530 BISHOPS LODGE RD
SANTA FE NM
87506-0005
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-1293
  • Fax: 505-467-8309
Mailing address:
  • Phone: 505-983-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0063434
License Number StateFL

VIII. Authorized Official

Name: DR. ROY HEILBRON
Title or Position: DIRECTOR
Credential: MD
Phone: 305-466-3954