Healthcare Provider Details

I. General information

NPI: 1083201917
Provider Name (Legal Business Name): ALPHA GAINZ INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2020
Last Update Date: 12/27/2020
Certification Date: 12/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1432
US

IV. Provider business mailing address

1612 VAIL PL SE
ALBUQUERQUE NM
87106-3912
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-0218
  • Fax:
Mailing address:
  • Phone: 505-400-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ABRIAN ARMENTA-MONTOYA
Title or Position: INCORPORATOR
Credential: CPT, CES, FNS
Phone: 505-400-0218