Provider Demographics
NPI:1942832001
Name:TRANSFORMED FOR LIFE, LLC
Entity Type:Organization
Organization Name:TRANSFORMED FOR LIFE, LLC
Other - Org Name:TRANSFORMED FOR LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMIJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-343-2010
Mailing Address - Street 1:316 OSUNA RD NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5950
Mailing Address - Country:US
Mailing Address - Phone:505-343-2010
Mailing Address - Fax:505-247-8881
Practice Address - Street 1:316 OSUNA RD NE STE 201
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5950
Practice Address - Country:US
Practice Address - Phone:505-343-2010
Practice Address - Fax:505-247-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty