Provider Demographics
NPI:1750845038
Name:APEX VIBRANCY CENTER
Entity Type:Organization
Organization Name:APEX VIBRANCY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:805-233-4998
Mailing Address - Street 1:406 ORTIZ DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1451
Mailing Address - Country:US
Mailing Address - Phone:505-595-4183
Mailing Address - Fax:
Practice Address - Street 1:2741 INDIAN SCHOOL RD NE STE 101
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2653
Practice Address - Country:US
Practice Address - Phone:505-255-8682
Practice Address - Fax:505-255-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1295156370OtherINDIVIDUAL NPI
NM1295156370Medicaid