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General NPI Number Information
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NPI Number | 1275459166
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Entity Type | Organization
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Legal Business Name | TRIBALIGHTS TT LLC
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 4001 OFFICE COURT DR STE 1007
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City | SANTA FE
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State | NM
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Zip | 87507-4929
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Country | US
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Telephone | 310-721-4398
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CORONADO LN
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City | SANTA FE
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State | NM
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Zip | 87505-2685
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHOENIX GERMANO
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Credential |
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Telephone | 310-721-4398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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