Healthcare Provider Details

I. General information

NPI: 1598103186
Provider Name (Legal Business Name): DESERT HERBALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205B SCHOOL OF MINES RD
SOCORRO NM
87801-4545
US

IV. Provider business mailing address

PO BOX 233
SOCORRO NM
87801-0233
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-4787
  • Fax: 575-835-4787
Mailing address:
  • Phone: 575-835-4787
  • Fax: 575-835-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number697
License Number StateNM

VIII. Authorized Official

Name: DR. JEANNE DIXON
Title or Position: OWNER
Credential: DOM
Phone: 575-835-4787