| New Mexico Wellness Center Llc | |
|
4111 Barbara Loop Se Ste E1 Rio Rancho NM 87124-1068 | |
| (505) 715-9587 | |
| (505) 792-7982 |
| Full Name | New Mexico Wellness Center Llc |
|---|---|
| Speciality | Counselor |
| Location | 4111 Barbara Loop Se Ste E1, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Stefanie Juliano (OWNER) |
| Authorized Official Contact | 5057159587 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Mexico Wellness Center Llc 2737 Bayas Rd Se Rio Rancho NM 87124-2971 Ph: (505) 715-9587 | New Mexico Wellness Center Llc 4111 Barbara Loop Se Ste E1 Rio Rancho NM 87124-1068 Ph: (505) 715-9587 |
| NPI Number | 1467083956 |
|---|---|
| Provider Enumeration Date | 02/03/2020 |
| Last Update Date | 02/03/2020 |
| Certification Date | 02/03/2020 |
| Medicare PECOS PAC ID | 7214340819 |
|---|---|
| Medicare Enrollment ID | O20201228001189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467083956 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Deidra Marie Cordova |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851806525 PECOS PAC ID: 1355753385 Enrollment ID: I20201216002722 |
| Provider Name | Jessica A Alle-corliss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992368476 PECOS PAC ID: 8729408794 Enrollment ID: I20210712000615 |
| Provider Name | Aaron David Schwartz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861733156 PECOS PAC ID: 7719127067 Enrollment ID: I20220527001354 |
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