Healthcare Provider Details

I. General information

NPI: 1679819023
Provider Name (Legal Business Name): UPWARD MOTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 ADAMS ST SE
ALBUQUERQUE NM
87108-2837
US

IV. Provider business mailing address

336 ADAMS ST SE
ALBUQUERQUE NM
87108-2837
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-1231
  • Fax:
Mailing address:
  • Phone: 505-268-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number1390786
License Number StateNM

VIII. Authorized Official

Name: LUIS MIGUEL ALVIDREZ
Title or Position: OWNER
Credential: B.S EXERCISE SCIENCE
Phone: 505-268-1231