Provider Demographics
NPI:1376205666
Name:HEAL YOUR BODY & MIND MEDICAL GROUP
Entity type:Organization
Organization Name:HEAL YOUR BODY & MIND MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-742-5972
Mailing Address - Street 1:9924 TAMARACK LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-0913
Mailing Address - Country:US
Mailing Address - Phone:702-742-5972
Mailing Address - Fax:
Practice Address - Street 1:9924 TAMARACK LANDING WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-0913
Practice Address - Country:US
Practice Address - Phone:702-742-5972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty