Healthcare Provider Details

I. General information

NPI: 1568181840
Provider Name (Legal Business Name): VIVIFY SPECIALTY INFUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CARMEL AVE NE STE 601
ALBUQUERQUE NM
87122-3125
US

IV. Provider business mailing address

8300 CARMEL AVE NE STE 601
ALBUQUERQUE NM
87122-3125
US

V. Phone/Fax

Practice location:
  • Phone: 505-677-8842
  • Fax:
Mailing address:
  • Phone: 505-677-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID A NEWMAN
Title or Position: OWNER
Credential:
Phone: 505-677-8842