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General NPI Number Information
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NPI Number | 1194264234
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Entity Type | Organization
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Legal Business Name | ZENTRAL WELLNESS
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 3904 CENTRAL AVE SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-1017
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Country | US
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Telephone | 505-604-5857
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Fax |
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Provider Business Mailing Address
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Address Line | 3904 CENTRAL AVE SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-1017
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Country | US
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Telephone | 505-604-5857
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISABETH DETWILER
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Credential | D.O.M
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Telephone | 505-266-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1127
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License Number State | NM
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