Organization
LIFECARE HEALTH & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENSO SELIM CAMPOS SANDOVAL (SINGLE MEMBER)
(505) 603-8099
Entity
Organization
Contact information
Practice address
130 SIRINGO RD, SUITE 201, SANTA FE, NM 87505-5863
(505) 989-3236
(505) 989-5079
Mailing address
146 GLORY LN, GLORIETA, NM 87535-7086
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP00519
NM
363LF0000X
Family Nurse Practitioner
CNP00935
NM
Other
Enumeration date
03/19/2015
Last updated
03/19/2015
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