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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