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Organization
SAN JUAN HEALTH AND WELLNESS CENTER
Active
Organization
SAN JUAN HEALTH AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY DAWN DIAZ (OFFICE ADMINISTRATOR)
(505) 327-0002
Entity
Organization
Contact information
Practice address
4801 N BUTLER AVE, STE 1101, FARMINGTON, NM 87401-1013
(505) 327-0002
(505) 325-9443
Mailing address
4801 N BUTLER AVE, STE 1101, FARMINGTON, NM 87401-1013
(505) 327-0002
(505) 325-9443
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2782
LAST FOUR OF TIN
NM
05
—
86337556
—
NM
Enumeration date
05/03/2017
Last updated
12/29/2023
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