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General NPI Number Information
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NPI Number | 1982930160
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Entity Type | Organization
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Legal Business Name | SYNERGY WELLNESS CENTER LLC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 3600 RODEO LN 5B
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City | SANTA FE
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State | NM
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Zip | 87507-6400
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Country | US
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Telephone | 505-292-9700
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Fax | 505-867-2566
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Provider Business Mailing Address
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Address Line | 3600 RODEO LANE 5B
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City | SANTA FE
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State | NM
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Zip | 87507-5801
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Country | US
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Telephone | 505-292-9700
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Fax | 505-867-2566
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GLORIA ISABEL GERSTNER
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Credential | DPM MS
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Telephone | 505-292-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 307
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License Number State | NM
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