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General NPI Number Information
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NPI Number | 1063788701
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Entity Type | Organization
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Legal Business Name | INTEGRATED WELLNESS
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 10209 NACIMIENTO ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4457
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Country | US
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Telephone | 505-433-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 10209 NACIMIENTO ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4457
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Country | US
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Telephone | 505-433-0335
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | JOSHUA KAWIKA PEIPER
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Credential |
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Telephone | 505-433-0335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | FA01022864
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License Number State | NM
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