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General NPI Number Information
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NPI Number | 1780059469
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Entity Type | Organization
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Legal Business Name | LOTUS FAMILY HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 4504 4TH ST NW STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-3956
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Country | US
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Telephone | 505-896-1222
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Fax | 505-896-1444
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Provider Business Mailing Address
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Address Line | 12231 ACADEMY RD NE STE 301-117
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-7236
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Country | US
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Telephone | 505-896-1222
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Fax | 505-896-1444
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Authorized Official
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Title or Position | OWNER
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Name | DR. YVONNE VANARSDALE-IMANI
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Credential | M.D.
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Telephone | 505-896-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD2004-0550
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License Number State | NM
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