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Organization
NM SPIRIT OF WELLNESS LLC
Active
Organization
NM SPIRIT OF WELLNESS LLC
Active
Other names
NM Spirit of wellness LC
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNETT MARTINEZ NP (CEO)
(505) 264-9454
Entity
Organization
Contact information
Practice address
123 GIRARD BLVD SE, ALBUQUERQUE, NM 87106-2227
(505) 264-9454
(505) 557-1941
Mailing address
123 GIRARD BLVD SE, ALBUQUERQUE, NM 87106-2227
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14350673
—
NM
Enumeration date
03/18/2019
Last updated
10/20/2019
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