| Tribalights Tt Llc | |
|
20 Road 2050 Aztec NM 87410-3004 | |
| (310) 721-4398 | |
| Not Available |
| Full Name | Tribalights Tt Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 20 Road 2050, Aztec, New Mexico |
| Authorized Official Name and Position | Phoenix Germano (CO-FOUNDER & COO) |
| Authorized Official Contact | 3107214398 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tribalights Tt Llc 20548 Ventura Blvd # 10-407 Woodland Hills CA 91364-6225 Ph: () - | Tribalights Tt Llc 20 Road 2050 Aztec NM 87410-3004 Ph: (310) 721-4398 |
| NPI Number | 1568241669 |
|---|---|
| Provider Enumeration Date | 09/27/2023 |
| Last Update Date | 09/29/2023 |
| Medicare PECOS PAC ID | 1658729165 |
|---|---|
| Medicare Enrollment ID | O20231122000217 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568241669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
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