MEDICARE: LOS MILAGROS ENTERPRISES,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	5526	NM

General Provider Information

NPI Number	:	1558595629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS MILAGROS ENTERPRISES,LLC

Provider Business Mailing Address
First Line	:	3909 JUAN TABO BLVD NE STE 4
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3973
Country	:	US
Telephone Number	:	505-332-8979
Fax Number	:	505-332-8806

Provider Business Practice Location Address
First Line	:	3909 JUAN TABO BLVD NE STE 4
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3973
Country	:	US
Telephone Number	:	505-332-8979
Fax Number	:	505-332-8806

Authorized Official
Title or Position	:	OWNER
Name	:	LUCINDA LEONORA PADILLA
Credential	:	LMT,MMP,NCTM
Telephone Number	:	505-332-8979

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	05/05/2009

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