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General NPI Number Information
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NPI Number | 1366264111
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Entity Type | Organization
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Legal Business Name | DESERT WOLF HEALTHCARE LLC
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 2509 VIRGINIA ST NE STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4695
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Country | US
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Telephone | 505-318-0717
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Fax | 505-349-0803
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Provider Business Mailing Address
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Address Line | 1510 WINDMILL CT NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5605
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Country | US
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Telephone | 505-459-7637
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Fax | 505-349-0803
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHRISTOPHER STEVEN MYERS
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Credential | DO
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Telephone | 505-318-0717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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