Provider Demographics
NPI:1336555853
Name:LA BELLA SPA SALON
Entity Type:Organization
Organization Name:LA BELLA SPA SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-899-5557
Mailing Address - Street 1:9687 ASBURY LN NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4344
Mailing Address - Country:US
Mailing Address - Phone:505-206-2378
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:505-899-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT2169111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty