Healthcare Provider Details

I. General information

NPI: 1356254759
Provider Name (Legal Business Name): QUETZALLI HEALTH & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N RESLER DR APT 2605
EL PASO TX
79911-2252
US

IV. Provider business mailing address

1600 N RESLER DR APT 2605
EL PASO TX
79911-2252
US

V. Phone/Fax

Practice location:
  • Phone: 830-719-3594
  • Fax:
Mailing address:
  • Phone: 830-719-3594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SELENE QUETZAL LOPEZ
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 830-719-3594