MEDICARE: MI VIDA WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1891649679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI VIDA WELLNESS PLLC

Provider Business Mailing Address
First Line	:	1209 MOUNTAIN ROAD PL NE STE R
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7825
Country	:	US
Telephone Number	:	505-355-0835
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 SAN MATEO BLVD NE APT 2004
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2603
Country	:	US
Telephone Number	:	505-355-0835
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LUCIA FRAIRE
Credential	:
Telephone Number	:	505-355-0835

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	03/10/2026

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