| NPI | 1447490800 |
|---|---|
| Doing Business As | MESA VISTA WELLNESS |
| Entity Type | Organization |
| Authorized Contact | TOD L DICECCO Executive Director/Owner 505-490-1984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NM 0119891) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2022-02-10 |