Healthcare Provider Details

I. General information

NPI: 1356256994
Provider Name (Legal Business Name): LAVISH MINDFULNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 BROADWAY BLVD SE
ALBUQUERQUE NM
87105-7414
US

IV. Provider business mailing address

9701 MONTGOMERY BLVD NE # 1096
ALBUQUERQUE NM
87111-3501
US

V. Phone/Fax

Practice location:
  • Phone: 505-456-2363
  • Fax: 505-210-8793
Mailing address:
  • Phone: 505-456-2363
  • Fax: 505-210-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KARLA RADOSEVICH
Title or Position: OWNER
Credential: PMHNP
Phone: 505-456-2363