Healthcare Provider Details

I. General information

NPI: 1982541330
Provider Name (Legal Business Name): LAVISH MINDFULNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 VENICE AVE NE
ALBUQUERQUE NM
87113-2161
US

IV. Provider business mailing address

9701 MONTGOMERY BLVD NE # 1096
ALBUQUERQUE NM
87111-3501
US

V. Phone/Fax

Practice location:
  • Phone: 505-456-2363
  • Fax:
Mailing address:
  • Phone: 505-456-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: KARLA DEANNE RADOSEVICH
Title or Position: PRESIDENT
Credential: PMHNP
Phone: 505-456-2363