Provider Demographics
NPI:1831367093
Name:METARELIS, DEMOSTHENES STEPHEN
Entity type:Individual
Prefix:MR
First Name:DEMOSTHENES
Middle Name:STEPHEN
Last Name:METARELIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DEMO
Other - Middle Name:
Other - Last Name:METARELIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:829 CLAUDINE NE
Mailing Address - Street 2:MASSAGE THERAPY WITH LOVE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1224
Mailing Address - Country:US
Mailing Address - Phone:505-296-4396
Mailing Address - Fax:
Practice Address - Street 1:8006 MENAUL NE
Practice Address - Street 2:MASSAGE THERAPY WITH LOVE AT ALIVE & WELL CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4608
Practice Address - Country:US
Practice Address - Phone:505-271-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00RJ54OtherBLUE CROSS BLUE SHIELD