Organization
LA BONNA VITA COSMETIC SPA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LESTER (MANAGING MEMBER)
(505) 453-7886
Entity
Organization
Contact information
Practice address
4333 PAN AMERICAN FWY NE, SUITE C, ALBUQUERQUE, NM 87107-6831
(505) 344-6334
Mailing address
4333 PAN AMERICAN FWY NE, SUITE C, ALBUQUERQUE, NM 87107-6831
(505) 344-6334
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
89-270
NM
Other
Enumeration date
12/03/2009
Last updated
12/03/2009
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