Provider Demographics
NPI:1508389784
Name:AZTEC SPA AND WELLNESS
Entity Type:Organization
Organization Name:AZTEC SPA AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARQUHARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:505-320-1850
Mailing Address - Street 1:5200 VILLA VIEW DR APT 12A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-8255
Mailing Address - Country:US
Mailing Address - Phone:505-320-1850
Mailing Address - Fax:
Practice Address - Street 1:1415 W AZTEC BLVD STE 4
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-1899
Practice Address - Country:US
Practice Address - Phone:505-320-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8154225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1194253401OtherINSURANCE