Healthcare Provider Details

I. General information

NPI: 1194687681
Provider Name (Legal Business Name): NEXUS VITALITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 MENAUL BLVD NE # 1107
ALBUQUERQUE NM
87110-3379
US

IV. Provider business mailing address

6001 MENAUL BLVD NE # 1107
ALBUQUERQUE NM
87110-3379
US

V. Phone/Fax

Practice location:
  • Phone: 702-945-8262
  • Fax:
Mailing address:
  • Phone: 702-945-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMMY NZIVO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 702-945-8262