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General NPI Number Information
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NPI Number | 1821978289
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTH AND WELLNESS CLINIC INTEGRATIVE MEDICINE LLC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 705 MAIN ST SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-8308
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Country | US
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Telephone | 505-808-1866
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Fax |
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Provider Business Mailing Address
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Address Line | 705 MAIN ST SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-8308
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Country | US
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Telephone | 505-808-1866
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Fax | 505-808-6966
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JAHNELLE GARCIA
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Credential |
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Telephone | 505-239-9146
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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 |
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License Number State |
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