=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962384438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAAKU HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 B VETERANS BLVD
-----------------------------------------------------
City | SAN FIDEL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-280-7200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 40
-----------------------------------------------------
City | SAN FIDEL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87049-0040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-280-7720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JANAY MAUPIN
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 505-280-7720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------