=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881482651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VYE WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2025
-----------------------------------------------------
Last Update Date | 05/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1290 MCNUTT RD STE C
-----------------------------------------------------
City | SUNLAND PARK
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88063-9642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-227-8271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6300 RIVERSIDE PLAZA LN NW STE 118
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87120-2617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANDREW LEYVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 915-227-8271
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------