Healthcare Provider Details

I. General information

NPI: 1518887330
Provider Name (Legal Business Name): OPTIMIZED WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAMINO DEL SENADOR
TIJERAS NM
87059-7420
US

IV. Provider business mailing address

1 CAMINO DEL SENADOR
TIJERAS NM
87059-7420
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-2859
  • Fax: 505-990-7350
Mailing address:
  • Phone: 505-417-2859
  • Fax: 505-990-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALICIA LACOVARA
Title or Position: BUSINESS OWNER, PRACTITIONER
Credential: NP
Phone: 505-417-2859