NPIMap

Organization Active NPI

La Bonna Vita Cosmetic Spa, LLC

  • Adult Medicine Physician
  • Albuquerque, NM
National Provider Identifier
1861720757
Registry record updated Dec 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
89-270 Issued in NM
Legal business name
LA BONNA VITA COSMETIC SPA, LLC
Practice address
4333 Pan American Fwy NE
Suite C
Albuquerque, NM 87107-6831
Phone
(505) 344-6334
NPI assigned
Dec 3, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Lester
Title
Managing Member
Phone
(505) 453-7886

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X 89-270 NM Primary

Addresses

Primary practice location

4333 Pan American Fwy NE
Suite C
Albuquerque, NM 87107-6831

Mailing address

4333 Pan American Fwy NE
Suite C
Albuquerque, NM 87107-6831
Phone (505) 344-6334

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259798400000",
    "number": "1861720757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4333 PAN AMERICAN FWY NE",
            "address_2": "SUITE C",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871076831",
            "telephone_number": "505-344-6334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4333 PAN AMERICAN FWY NE",
            "address_2": "SUITE C",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871076831",
            "telephone_number": "505-344-6334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA BONNA VITA COSMETIC SPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-03",
        "last_updated": "2009-12-03",
        "status": "A",
        "authorized_official_last_name": "LESTER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "505-453-7886"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NM",
            "license": "89-270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.