Healthcare Provider Details

I. General information

NPI: 1316877525
Provider Name (Legal Business Name): TRIBALIGHTS ABQ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CORONADO LN
SANTA FE NM
87505-2685
US

IV. Provider business mailing address

4001 OFFICE COURT DR STE 1006
SANTA FE NM
87507-4929
US

V. Phone/Fax

Practice location:
  • Phone: 310-721-4398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PHOENIX GERMANO
Title or Position: OWNER
Credential:
Phone: 310-721-4398