Healthcare Provider Details

I. General information

NPI: 1760850416
Provider Name (Legal Business Name): HEART BRAIN INTERNATIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 LOS ARBOLES AVE NE # A-200
ALBUQUERQUE NM
87107-1962
US

IV. Provider business mailing address

1312 SIERRA LARGA DR. NE
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-5301
  • Fax:
Mailing address:
  • Phone: 505-933-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number102651
License Number StateNM

VIII. Authorized Official

Name: DAVID ZIMPELMAN
Title or Position: REGISTERED AGENT
Credential: MBR
Phone: 505-933-5301