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General NPI Number Information
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NPI Number | 1376338368
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Entity Type | Organization
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Legal Business Name | VIZIONZ-SANKOFA
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 5400 GIBSON BLVD SE BUILDING 11
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City | ALBUQUERQUE
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State | NM
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Zip | 87108
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Country | US
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Telephone | 505-832-7141
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 GIBSON BLVD SE STE 9
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5181
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Country | US
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Telephone | 505-832-7141
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Fax |
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Authorized Official
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Title or Position | FOUNDER/DIRECTOR
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Name | KHADIJAH ASILI BOTTOM
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Credential |
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Telephone | 505-832-7141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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