SAN JUAN HEALTH AND WELLNESS CENTER NPI 1568998029

NPI Information

  • NPI: 1568998029
  • Provider Name: SAN JUAN HEALTH AND WELLNESS CENTER
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • Address: 4801 N BUTLER AVE
    STE 1101
    FARMINGTON, NM
    ZIP 87401
  • Phone: (505) 327-0002

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NPI Details

SAN JUAN HEALTH AND WELLNESS CENTER is a psychiatric/mental health nurse practitioner in Farmington, NM. SAN JUAN HEALTH AND WELLNESS CENTER NPI is 1568998029. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4801 N BUTLER AVE
STE 1101
FARMINGTON, NM
ZIP 87401-013
Phone: (505) 327-0002
Fax: (505) 325-9443

The provider's authorized official is Misty Dawn Diaz .
The authorized official title is Office Administrator and has the following contact phone number (505) 327-0002.

The enumeration date for this NPI number is 5/3/2017 and was last updated on 12/29/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11041C0700XSocial WorkerClinicalNo
22084P0800XPsychiatry & NeurologyPsychiatryNo
3363LF0000XNurse PractitionerFamilyNo
4363LP0808XNurse PractitionerPsychiatric/Mental HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
186337556MEDICAIDNEW MEXICO
22782OTHERNEW MEXICOLAST FOUR OF TIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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