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General NPI Number Information
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NPI Number | 1710805320
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Entity Type | Organization
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Legal Business Name | TRIFECTA LIGHT CENTER LLC
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 10000 COORS BYP NW STE G221
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4085
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Country | US
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Telephone | 505-309-4733
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Fax |
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Provider Business Mailing Address
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Address Line | 10000 COORS BYP NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4040
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Country | US
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Telephone | 505-309-4733
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Fax |
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Authorized Official
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Title or Position | CONTRACT SERVICE MGR
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Name | WARREN HILLS
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Credential |
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Telephone | 504-235-4336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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