Provider Demographics
NPI:1760934269
Name:WHEELER-SAGIAO, EVA (LMT & CPT)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:WHEELER-SAGIAO
Suffix:
Gender:F
Credentials:LMT & CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 WADE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9511
Mailing Address - Country:US
Mailing Address - Phone:808-343-0123
Mailing Address - Fax:
Practice Address - Street 1:2800 WADE BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9511
Practice Address - Country:US
Practice Address - Phone:808-343-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8434225700000X
HI14180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMIVIAMedicaid