Provider Demographics
NPI:1558595629
Name:LOS MILAGROS ENTERPRISES,LLC
Entity Type:Organization
Organization Name:LOS MILAGROS ENTERPRISES,LLC
Other - Org Name:KOKOPELLI BODYWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:LEONORA
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT,MMP,NCTM
Authorized Official - Phone:505-332-8979
Mailing Address - Street 1:3909 JUAN TABO BLVD NE STE 4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3973
Mailing Address - Country:US
Mailing Address - Phone:505-332-8979
Mailing Address - Fax:505-332-8806
Practice Address - Street 1:3909 JUAN TABO BLVD NE STE 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3973
Practice Address - Country:US
Practice Address - Phone:505-332-8979
Practice Address - Fax:505-332-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty