Provider Demographics
NPI:1710876719
Name:ABQ WELLNESS PC
Entity type:Organization
Organization Name:ABQ WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MESTAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:505-999-0470
Mailing Address - Street 1:2900 LOUISIANA BLVD NE STE A2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3550
Mailing Address - Country:US
Mailing Address - Phone:505-999-0470
Mailing Address - Fax:
Practice Address - Street 1:2900 LOUISIANA BLVD NE STE A2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3550
Practice Address - Country:US
Practice Address - Phone:505-999-0470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty