Healthcare Provider Details

I. General information

NPI: 1003066911
Provider Name (Legal Business Name): DOUBLE HAPPINESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2008
Last Update Date: 09/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 PONDEROSA AVE NE
ALBUQUERQUE NM
87110-8207
US

IV. Provider business mailing address

4104 PONDEROSA AVE NE
ALBUQUERQUE NM
87110-8207
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-4127
  • Fax: 505-265-5041
Mailing address:
  • Phone: 505-385-4127
  • Fax: 505-265-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number747
License Number StateNM

VIII. Authorized Official

Name: DR. MARY-BETH THOMPSON
Title or Position: OWNER
Credential: D.O.M.
Phone: 505-385-4127