Healthcare Provider Details

I. General information

NPI: 1114100302
Provider Name (Legal Business Name): LUDMILA REINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUDMILA THYGANOVA

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 GOLF COURSE RD NW C-2A
ALBUQUERQUE NM
87120-5842
US

IV. Provider business mailing address

1005 21ST ST SE STE 8
RIO RANCHO NM
87124-4030
US

V. Phone/Fax

Practice location:
  • Phone: 505-349-1491
  • Fax:
Mailing address:
  • Phone: 505-249-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4497
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: