Provider Demographics
NPI:1821643461
Name:SOARING EAGLES WELLNESS CENTER
Entity Type:Organization
Organization Name:SOARING EAGLES WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-365-9766
Mailing Address - Street 1:2971 JUNIPER HILLS BLVD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-2973
Mailing Address - Country:US
Mailing Address - Phone:714-365-9766
Mailing Address - Fax:
Practice Address - Street 1:2971 JUNIPER HILLS BLVD UNIT 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-2973
Practice Address - Country:US
Practice Address - Phone:714-365-9766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health