Provider Demographics
NPI:1821537226
Name:OCEAN BLUE MEDICAL MASSAGE AND SPA LLC
Entity Type:Organization
Organization Name:OCEAN BLUE MEDICAL MASSAGE AND SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:505-883-1212
Mailing Address - Street 1:9204 MENAUL BLVD NE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2256
Mailing Address - Country:US
Mailing Address - Phone:505-883-1212
Mailing Address - Fax:505-872-2917
Practice Address - Street 1:9204 MENAUL BLVD NE STE 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2201
Practice Address - Country:US
Practice Address - Phone:505-883-1212
Practice Address - Fax:505-872-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty