Healthcare Provider Details

I. General information

NPI: 1164204657
Provider Name (Legal Business Name): TRENZITAS DE AMOR MENTAL HEALTH & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4627 12TH ST NW
ALBUQUERQUE NM
87107-3705
US

IV. Provider business mailing address

4627 12TH ST NW
ALBUQUERQUE NM
87107-3705
US

V. Phone/Fax

Practice location:
  • Phone: 575-993-3790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ELISA DEVARGAS
Title or Position: OWNER
Credential:
Phone: 575-993-3790