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General NPI Number Information
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NPI Number | 1689177156
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Entity Type | Organization
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Legal Business Name | NEW MEXICO NATURAL HEALTH
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 35 OLD AGUA FRIA RD E
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City | SANTA FE
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State | NM
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Zip | 87508-5970
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Country | US
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Telephone | 505-629-6676
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8239
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City | SANTA FE
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State | NM
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Zip | 87504-8239
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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 | SOLE MEMBER OWNER
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Name | KELLY FRITH
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Credential |
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Telephone | 505-629-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | NM
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