Provider Demographics
NPI:1598103186
Name:DESERT HERBALS LLC
Entity Type:Organization
Organization Name:DESERT HERBALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:575-835-4787
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-0233
Mailing Address - Country:US
Mailing Address - Phone:575-835-4787
Mailing Address - Fax:575-835-4787
Practice Address - Street 1:205B SCHOOL OF MINES RD
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4545
Practice Address - Country:US
Practice Address - Phone:575-835-4787
Practice Address - Fax:575-835-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM697261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center