Healthcare Provider Details

I. General information

NPI: 1730506494
Provider Name (Legal Business Name): LIFE ENHANCEMENT SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 CARMEL AVE NE STE. 102
ALBUQUERQUE NM
87122-2941
US

IV. Provider business mailing address

1740 GRANDE BLVD SE STE. C & D
RIO RANCHO NM
87124-1799
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-0402
  • Fax: 505-892-5544
Mailing address:
  • Phone: 505-892-0402
  • Fax: 505-892-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD2005-0713
License Number StateNM

VIII. Authorized Official

Name: DR. ARMIN FOGHI
Title or Position: CARDIOLOGIST
Credential: M.D. PH.D
Phone: 505-892-0402