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General NPI Number Information
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NPI Number | 1669866463
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Entity Type | Organization
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Legal Business Name | LIFECARE HEALTH & WELLNESS
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 130 SIRINGO RD SUITE 201
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City | SANTA FE
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State | NM
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Zip | 87505-5863
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Country | US
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Telephone | 505-989-3236
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Fax | 505-989-5079
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Provider Business Mailing Address
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Address Line | 146 GLORY LN
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City | GLORIETA
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State | NM
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Zip | 87535-7086
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SINGLE MEMBER
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Name | RENSO SELIM CAMPOS SANDOVAL
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Credential |
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Telephone | 505-603-8099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP00935
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP00519
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License Number State | NM
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