Healthcare Provider Details

I. General information

NPI: 1982930160
Provider Name (Legal Business Name): SYNERGY WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 RODEO LN 5B
SANTA FE NM
87507-6400
US

IV. Provider business mailing address

3600 RODEO LANE 5B
SANTA FE NM
87507-5801
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-9700
  • Fax: 505-867-2566
Mailing address:
  • Phone: 505-292-9700
  • Fax: 505-867-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number307
License Number StateNM

VIII. Authorized Official

Name: DR. GLORIA ISABEL GERSTNER
Title or Position: PHYSICIAN
Credential: DPM MS
Phone: 505-292-9700