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General NPI Number Information
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NPI Number | 1013643410
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Entity Type | Organization
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Legal Business Name | MARIPOSA HEALTH & BEAUTY SPA
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 2019 GALISTEO ST STE M5
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City | SANTA FE
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State | NM
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Zip | 87505-2106
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Country | US
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Telephone | 505-699-9466
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Fax |
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Provider Business Mailing Address
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Address Line | 2019 GALISTEO ST STE M5
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City | SANTA FE
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State | NM
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Zip | 87505-2106
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Country | US
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Telephone | 505-699-9466
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Fax |
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | MARY ELLEN LOPEZ
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Credential | FNP
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Telephone | 505-690-9344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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