| NPI | 1457639262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE UKANWA Owner/Physician Provider 505-881-5307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 133N00000X Nutritionist |
| 207RA0401X Internal Medicine Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2019-04-11 |