Provider Demographics
NPI:1598067183
Name:NEW SELF LOVE FOUNDATION . INC
Entity Type:Organization
Organization Name:NEW SELF LOVE FOUNDATION . INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGUERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-987-2719
Mailing Address - Street 1:P.O. BOX 166
Mailing Address - Street 2:123 PAWHUSKA DRIVE
Mailing Address - City:TIMBERON
Mailing Address - State:NM
Mailing Address - Zip Code:88350
Mailing Address - Country:US
Mailing Address - Phone:575-987-2719
Mailing Address - Fax:
Practice Address - Street 1:123 PAWHUSKA DRIVE
Practice Address - Street 2:
Practice Address - City:TIMBERON
Practice Address - State:NM
Practice Address - Zip Code:88350
Practice Address - Country:US
Practice Address - Phone:575-987-2719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2962215302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization