1902783483 NPI number — WISE AND WELL NATURAL AND MEDICAL INTEGRATIVE CLINIC, LLC.

Table of content: (NPI 1902783483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902783483 NPI number — WISE AND WELL NATURAL AND MEDICAL INTEGRATIVE CLINIC, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISE AND WELL NATURAL AND MEDICAL INTEGRATIVE CLINIC, LLC.
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902783483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 LOUISIANA BLVD NE STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-4339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-372-0858
Provider Business Mailing Address Fax Number:
505-209-7905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 LOUISIAN BLVD NE
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-372-0858
Provider Business Practice Location Address Fax Number:
505-209-7905
Provider Enumeration Date:
08/18/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MONTOYA
Authorized Official First Name:
HOPE
Authorized Official Middle Name:
JESSICA
Authorized Official Title or Position:
OWNER, MEDICAL DIRECTOR
Authorized Official Telephone Number:
505-718-9049

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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