NPIMap

Organization Active NPI

Mariposa Transformation Wellness Center, LLC

Doing business as Mariposa Transformation Wellness Center & Med Spa

  • Physician Assistant
  • Albuquerque, NM
National Provider Identifier
1962127878
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
MARIPOSA TRANSFORMATION WELLNESS CENTER, LLC
Doing business as
Mariposa Transformation Wellness Center & Med Spa
Practice address
4550 Eubank Blvd NE
Suite D205
Albuquerque, NM 87111-2565
Phone
(505) 234-6432
NPI assigned
Oct 4, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

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

Authorized official

Name
Ms. Michelle Renee Lucero, PA-CNPI 1194023671
Title
PA-C / Owner
Phone
(505) 234-6432

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X Primary
Medical Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363AM0700X
Surgical Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363AS0400X

Addresses

Primary practice location

4550 Eubank Blvd NE
Suite D205
Albuquerque, NM 87111-2565

Mailing address

4550 Eubank Blvd NE
Suite D205
Albuquerque, NM 87111
Phone (505) 234-6432

Other names 1

  • Mariposa Transformation Wellness Center & Med Spa Doing business as

National Provider Directory

National Provider Directory

Locations

4550 Eubank Blvd NE
Ste D205
Albuquerque, NM 87111
Phone (505) 234-6432

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1962127878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 EUBANK BLVD NE",
            "address_2": "SUITE D205",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87111",
            "telephone_number": "505-234-6432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 EUBANK BLVD NE",
            "address_2": "SUITE D205",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112565",
            "telephone_number": "505-234-6432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIPOSA TRANSFORMATION WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-04",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "LUCERO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PA-C /  OWNER",
        "authorized_official_telephone_number": "505-234-6432",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mariposa Transformation Wellness Center & Med Spa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mariposa Transformation Wellness Center & Med Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 30, 2023; 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.