Healthcare Provider Details

I. General information

NPI: 1144136243
Provider Name (Legal Business Name): MORADA LUZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 CHURCH ST
LAS VEGAS NM
87701-3724
US

IV. Provider business mailing address

109 TAOS ST
LAS VEGAS NM
87701-4147
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-8826
  • Fax:
Mailing address:
  • Phone: 505-690-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANAMARIA ARMIJO-GLENN
Title or Position: OWNER
Credential:
Phone: 505-690-8826