Organization
SELENITE HEALTH AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABIGAIL BANMBUH PMHNP (CEO)
(505) 225-1975
Entity
Organization
Contact information
Practice address
4300 RIDGECREST DR SE, RIO RANCHO, NM 87124-5907
(505) 225-1975
Mailing address
1199 MIRADOR LOOP NE, RIO RANCHO, NM 87144-5324
(281) 682-9067
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
12/28/2022
Last updated
12/28/2022
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