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General NPI Number Information
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NPI Number | 1568181840
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Entity Type | Organization
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Legal Business Name | VIVIFY SPECIALTY INFUSION LLC
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 8300 CARMEL AVE NE STE 601
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3125
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Country | US
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Telephone | 505-677-8842
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 CARMEL AVE NE STE 601
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3125
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Country | US
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Telephone | 505-677-8842
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID A NEWMAN
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Credential |
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Telephone | 505-677-8842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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