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General NPI Number Information
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NPI Number | 1093964546
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Entity Type | Organization
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Legal Business Name | A WELL FOR HEALTH INC
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 07/11/2011
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Provider Practice Location Address
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Address Line | 1530 BISHOPS LODGE RD
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City | SANTA FE
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State | NM
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Zip | 87506-0005
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Country | US
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Telephone | 505-983-1293
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Fax | 505-467-8309
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Provider Business Mailing Address
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Address Line | 1530 BISHOPS LODGE RD
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City | SANTA FE
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State | NM
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Zip | 87506-0005
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Country | US
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Telephone | 505-983-1293
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROY HEILBRON
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Credential | MD
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Telephone | 305-466-3954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0063434
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License Number State | FL
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