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General NPI Number Information
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NPI Number | 1528573995
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Entity Type | Organization
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Legal Business Name | BELLEZA MED SPA LLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 2469 CORRALES RD STE D
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City | CORRALES
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State | NM
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Zip | 87048-9148
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Country | US
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Telephone | 505-897-4433
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Fax |
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Provider Business Mailing Address
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Address Line | 2469 CORRALES RD STE D
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City | CORRALES
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State | NM
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Zip | 87048-9148
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Country | US
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Telephone | 505-897-4333
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Fax | 505-897-3085
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Authorized Official
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Title or Position | OWNER
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Name | EVA CHRISTINA PACHECO
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Credential | MD
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Telephone | 505-897-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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