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General NPI Number Information
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NPI Number | 1295407773
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Entity Type | Organization
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Legal Business Name | SOAR WELLNESS
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 6855 4TH ST NW STE B2
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6100
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Country | US
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Telephone | 505-398-9430
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Fax | 505-832-8516
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Provider Business Mailing Address
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Address Line | 804 ACAPULCO RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-6473
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Country | US
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Telephone | 505-514-5885
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Fax | 505-832-8516
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. STEPHANIE RAE ABEYTA
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Credential | NP
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Telephone | 505-398-9430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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