Lotus Family Health & Wellness, Llc | |
4504 4th St Nw Ste A Albuquerque NM 87107-3956 | |
(505) 896-1222 | |
(505) 896-1444 |
Full Name | Lotus Family Health & Wellness, Llc |
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Speciality | Clinic/Center |
Location | 4504 4th St Nw Ste A, Albuquerque, New Mexico |
Authorized Official Name and Position | Yvonne Vanarsdale-imani (OWNER) |
Authorized Official Contact | 5058961222 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lotus Family Health & Wellness, Llc 12231 Academy Rd Ne Ste 301-117 Albuquerque NM 87111-7236 Ph: (505) 896-1222 | Lotus Family Health & Wellness, Llc 4504 4th St Nw Ste A Albuquerque NM 87107-3956 Ph: (505) 896-1222 |
NPI Number | 1780059469 |
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Provider Enumeration Date | 12/07/2015 |
Last Update Date | 04/15/2021 |
Medicare PECOS PAC ID | 9032411236 |
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Medicare Enrollment ID | O20160105002026 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780059469 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | MD2004-0550 (New Mexico) | Primary |
Provider Name | Yvonne D Vanarsdale-imani |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1861497901 PECOS PAC ID: 9335191469 Enrollment ID: I20050218000088 |
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