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General NPI Number Information
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NPI Number | 1316658008
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Entity Type | Organization
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Legal Business Name | FALLEN ANGELS LLC
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 5104 SAN ADAN AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1834
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Country | US
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Telephone | 626-940-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 5104 SAN ADAN AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1834
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Country | US
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Telephone | 626-940-4511
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIAH RAE BROWN
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Credential | NP
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Telephone | 505-389-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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