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General NPI Number Information
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NPI Number | 1588488977
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Entity Type | Organization
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Legal Business Name | GAIA TREE INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1751 CALLE MEDICO STE O
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City | SANTA FE
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State | NM
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Zip | 87505-4706
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Country | US
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Telephone | 505-391-4242
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Fax | 505-439-7052
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Provider Business Mailing Address
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Address Line | 1751 CALLE MEDICO STE O
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City | SANTA FE
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State | NM
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Zip | 87505-4706
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Country | US
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Telephone | 505-391-4242
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Fax | 505-439-7052
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Authorized Official
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Title or Position | OWNER
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Name | CANDACE MILLER
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Credential | PA
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Telephone | 505-391-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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