Provider Demographics
NPI:1295407773
Name:SOAR WELLNESS
Entity Type:Organization
Organization Name:SOAR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ABEYTA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:505-398-9430
Mailing Address - Street 1:804 ACAPULCO RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-6473
Mailing Address - Country:US
Mailing Address - Phone:505-514-5885
Mailing Address - Fax:505-832-8516
Practice Address - Street 1:6855 4TH ST NW STE B2
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6100
Practice Address - Country:US
Practice Address - Phone:505-398-9430
Practice Address - Fax:505-832-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty