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General NPI Number Information
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NPI Number | 1285109561
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Entity Type | Organization
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Legal Business Name | WHOLE SELF RECOVERY
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 509 W PUEBLO DR
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City | ESPANOLA
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State | NM
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Zip | 87532-2508
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Country | US
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Telephone | 506-747-3368
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Fax | 505-367-0077
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Provider Business Mailing Address
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Address Line | PO BOX 4621
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City | SANTA FE
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State | NM
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Zip | 87502-4621
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Country | US
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Telephone | 505-920-6020
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Fax | 505-367-0077
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Authorized Official
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Title or Position | OWNER
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Name | DR. KARTAR KHALSA
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Credential | DOM
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Telephone | 505-920-6020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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