Organization
BUENA VIDA PHYSICAL THERAPY AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STELLA JEANNE BURCIAGA PT (PRESIDENT)
(505) 718-8309
Entity
Organization
Contact information
Practice address
601 E LINCOLN ST, LAS VEGAS, NM 87701-4502
(505) 425-2998
(505) 425-2897
Mailing address
601 E LINCOLN ST, LAS VEGAS, NM 87701-4502
(505) 425-2998
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
3283
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36072842
—
NM
Enumeration date
06/04/2008
Last updated
04/07/2020
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