MEDICARE: LOTUS FAMILY HEALTH & WELLNESS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	MD2004-0550	NM

General Provider Information

NPI Number	:	1780059469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS FAMILY HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	12231 ACADEMY RD NE
Second Line	:	STE 301-117
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-7236
Country	:	US
Telephone Number	:	505-896-1222
Fax Number	:	505-896-1444

Provider Business Practice Location Address
First Line	:	4504 4TH ST NW STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-3956
Country	:	US
Telephone Number	:	505-896-1222
Fax Number	:	505-896-1444

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YVONNE VANARSDALE-IMANI
Credential	:	M.D.
Telephone Number	:	505-896-1222

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	04/15/2021

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