1295329985 NPI number — WELLNESS FOCUS

Table of content: LORENZO PUERTAS JR. L.AC. (NPI 1356413983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295329985 NPI number — WELLNESS FOCUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLNESS FOCUS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295329985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 777122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89077-7122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-569-9444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3067 E WARM SPRINGS RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89120-3750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-569-9444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ULOFOSHIO
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-569-9444

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)