MEDICARE: ABQ WELLNESS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	251S00000X	Community/Behavioral Health Agency
3	363LF0000X	Family Nurse Practitioner
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1710876719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABQ WELLNESS PC

Provider Business Mailing Address
First Line	:	2900 LOUISIANA BLVD NE STE A2
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3550
Country	:	US
Telephone Number	:	505-999-0470
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 LOUISIANA BLVD NE STE A2
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3550
Country	:	US
Telephone Number	:	505-999-0470
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	NICOLE MESTAS
Credential	:	NP
Telephone Number	:	505-999-0470

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	04/06/2026

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Directions to “ABQ WELLNESS PC ” Practice Location

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