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General NPI Number Information
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NPI Number | 1598067183
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Entity Type | Organization
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Legal Business Name | NEW SELF LOVE FOUNDATION . INC
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 123 PAWHUSKA DRIVE
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City | TIMBERON
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State | NM
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Zip | 88350
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Country | US
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Telephone | 575-987-2719
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 166 123 PAWHUSKA DRIVE
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City | TIMBERON
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State | NM
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Zip | 88350
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Country | US
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Telephone | 575-987-2719
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | MS. MARGUERITA GASPARD
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Credential |
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Telephone | 575-987-2719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2962215
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License Number State | NM
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