Organization
MARIPOSA TRANSFORMATION WELLNESS CENTER, LLC
Active
Other names
Mariposa Transformation Wellness Center & Med Spa
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE RENEE LUCERO PA-C (PA-C / OWNER)
(505) 234-6432
Entity
Organization
Contact information
Practice address
4550 EUBANK BLVD NE, SUITE D205, ALBUQUERQUE, NM 87111-2565
(505) 234-6432
Mailing address
4550 EUBANK BLVD NE, SUITE D205, ALBUQUERQUE, NM 87111
(505) 234-6432
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
10/04/2022
Last updated
03/30/2023
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