Provider Demographics
NPI:1356411581
Name:ALPHA & OMGEA WELLNESS CENTER
Entity type:Organization
Organization Name:ALPHA & OMGEA WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUJA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:915-494-4468
Mailing Address - Street 1:3333 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2031
Mailing Address - Country:US
Mailing Address - Phone:915-494-4468
Mailing Address - Fax:915-833-8163
Practice Address - Street 1:3333 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2031
Practice Address - Country:US
Practice Address - Phone:915-494-4468
Practice Address - Fax:915-833-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7101OtherLICENSENUMBER