MEDICARE: ALPHA OMEGA WELLNESS CENTER, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0040HQ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1841383999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA OMEGA WELLNESS CENTER, INC.

Provider Business Mailing Address
First Line	:	4437 LAZY WILLOW DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79922-1857
Country	:	US
Telephone Number	:	915-521-2020
Fax Number	:	915-838-8163

Provider Business Practice Location Address
First Line	:	2630 MONTANA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-3712
Country	:	US
Telephone Number	:	915-521-2020
Fax Number	:	915-532-2348

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIUS RUJA
Credential	:	DC
Telephone Number	:	915-521-2020

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/20/2018

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