Provider Demographics
NPI:1881010676
Name:TRANQUILITY MEDICAL SPA CENTER
Entity Type:Organization
Organization Name:TRANQUILITY MEDICAL SPA CENTER
Other - Org Name:TRANQUILITY MEDICAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MARCELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMMT
Authorized Official - Phone:505-688-1306
Mailing Address - Street 1:8416 SAN FRANCISCO RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5002
Mailing Address - Country:US
Mailing Address - Phone:505-688-1306
Mailing Address - Fax:
Practice Address - Street 1:10126 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4022
Practice Address - Country:US
Practice Address - Phone:505-688-1306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty