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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