Provider Demographics
NPI:1639533516
Name:SOL WELLNESS
Entity type:Organization
Organization Name:SOL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:505-216-1119
Mailing Address - Street 1:PO BOX 22383
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-2383
Mailing Address - Country:US
Mailing Address - Phone:505-216-1119
Mailing Address - Fax:505-349-4748
Practice Address - Street 1:1807 2ND ST
Practice Address - Street 2:SUITE 44C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3499
Practice Address - Country:US
Practice Address - Phone:505-216-1119
Practice Address - Fax:505-349-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172P00000X
NMCNP-02467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty