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Organization
HEAVENLY HEALTH INC
Active
Organization
HEAVENLY HEALTH INC
Active
Other names
HEAVENLY HEALTH FNP
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGES DUVAL MD (VICE PRESIDENT)
(505) 722-6770
Entity
Organization
Contact information
Practice address
308 EAST HILL AVENUE, GALLUP, NM 87301
(505) 722-6770
(505) 722-6799
Mailing address
308 EAST HILL AVENUE, GALLUP, NM 87301
(505) 722-6770
(505) 722-6799
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S9269
—
NM
Enumeration date
12/12/2006
Last updated
11/08/2011
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