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General NPI Number Information
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NPI Number | 1487014957
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Entity Type | Organization
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Legal Business Name | SOUL HEALING CENTER
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 404 BRUNN SCHOOL RD STE C
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City | SANTA FE
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State | NM
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Zip | 87505-1102
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Country | US
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Telephone | 505-718-8673
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28339
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City | SANTA FE
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State | NM
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Zip | 87592-8339
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Country | US
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Telephone | 505-718-8673
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LUIGI DULANTO
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Credential | M.D.
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Telephone | 505-718-8673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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