Healthcare Provider Details

I. General information

NPI: 1710805320
Provider Name (Legal Business Name): TRIFECTA LIGHT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 COORS BYP NW STE G221
ALBUQUERQUE NM
87114-4085
US

IV. Provider business mailing address

10000 COORS BYP NW
ALBUQUERQUE NM
87114-4040
US

V. Phone/Fax

Practice location:
  • Phone: 505-309-4733
  • Fax:
Mailing address:
  • Phone: 505-309-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: WARREN HILLS
Title or Position: CONTRACT SERVICE MGR
Credential:
Phone: 504-235-4336