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General NPI Number Information
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NPI Number | 1346784287
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE & PERSONALIZED HORMONE THERAPY, LLC
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 5290 MCNUTT RD STE 105
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City | SANTA TERESA
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State | NM
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Zip | 88008-9648
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Country | US
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Telephone | 575-502-3303
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Fax | 575-205-0254
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Provider Business Mailing Address
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Address Line | 5290 MCNUTT RD STE 105
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City | SANTA TERESA
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State | NM
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Zip | 88008-9648
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Country | US
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Telephone | 575-502-3303
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Fax | 575-205-0254
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA BLANCO
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Credential | DNP, APRN
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Telephone | 915-217-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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