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General NPI Number Information
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NPI Number | 1821620659
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Entity Type | Organization
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Legal Business Name | EQUILIBRIUM NATURAL CLINIC LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 96 CONNECTICUT BLVD
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City | EAST HARTFORD
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State | CT
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Zip | 06108-3013
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Country | US
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Telephone | 860-615-7758
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Fax |
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Provider Business Mailing Address
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Address Line | 165 SIGOURNEY ST APT C4
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City | HARTFORD
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State | CT
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Zip | 06105-1913
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Country | US
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Telephone | 860-719-8882
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILBERTO LUGO
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Credential | D
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Telephone | 860-719-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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