Healthcare Provider Details

I. General information

NPI: 1437295706
Provider Name (Legal Business Name): LIFE SUSTAINABILITY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 LOMAS BLVD NE STE 103
ALBUQUERQUE NM
87112-5462
US

IV. Provider business mailing address

10601 LOMAS BLVD NE STE 103
ALBUQUERQUE NM
87112-5462
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-5995
  • Fax: 505-298-2940
Mailing address:
  • Phone: 505-298-5995
  • Fax: 505-298-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. REX DRAMAN
Title or Position: PRESIDENT
Credential: PHD
Phone: 512-659-4304