Healthcare Provider Details

I. General information

NPI: 1881010676
Provider Name (Legal Business Name): TRANQUILITY MEDICAL SPA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10126 COORS BLVD NW
ALBUQUERQUE NM
87114-4022
US

IV. Provider business mailing address

8416 SAN FRANCISCO RD NE
ALBUQUERQUE NM
87109-5002
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-1306
  • Fax:
Mailing address:
  • Phone: 505-688-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. HEATHER ELIZABETH MARCELLUS
Title or Position: OWNER
Credential: LMMT
Phone: 505-688-1306