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General NPI Number Information
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NPI Number | 1508389784
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Entity Type | Organization
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Legal Business Name | AZTEC SPA AND WELLNESS
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 1415 W AZTEC BLVD STE 4
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City | AZTEC
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State | NM
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Zip | 87410-1899
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Country | US
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Telephone | 505-320-1850
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 VILLA VIEW DR APT 12A
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City | FARMINGTON
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State | NM
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Zip | 87402-8255
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Country | US
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Telephone | 505-320-1850
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TONI FARQUHARSON
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Credential | LMT
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Telephone | 505-320-1850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8154
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License Number State | NM
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