Organization
NM SPIRIT OF WELLNESS LLC
Active
Other names
NM Spirit of wellness LC
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNETT MARTINEZ NP (CEO)
(505) 264-9454
Entity
Organization
Contact information
Practice address
123 GIRARD BLVD SE, ALBUQUERQUE, NM 87106-2227
(505) 264-9454
(505) 557-1941
Mailing address
123 GIRARD BLVD SE, ALBUQUERQUE, NM 87106-2227
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14350673
—
NM
Enumeration date
03/18/2019
Last updated
10/20/2019
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