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Individual

MS. LEA WILDFLOWER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CMP

Contact information

Practice address
500 RODEO RD RM 4, SANTA FE, NM 87505-6378
(415) 320-3819
Mailing address
941 CALLE MEJIA APT 511, SANTA FE, NM 87501-1464
(415) 320-3819

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2024-0172
NM
225700000X
Massage Therapist
22150
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
22150
CAMTC
CA
01
MT20240172
STATE
NM
Enumeration date
07/28/2017
Last updated
11/17/2025
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