Provider Demographics
NPI:1730506494
Name:LIFE ENHANCEMENT SPECIALISTS LLC
Entity type:Organization
Organization Name:LIFE ENHANCEMENT SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:505-892-0402
Mailing Address - Street 1:1740 GRANDE BLVD SE
Mailing Address - Street 2:STE. C & D
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1799
Mailing Address - Country:US
Mailing Address - Phone:505-892-0402
Mailing Address - Fax:505-892-5544
Practice Address - Street 1:8200 CARMEL AVE NE
Practice Address - Street 2:STE. 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2941
Practice Address - Country:US
Practice Address - Phone:505-892-0402
Practice Address - Fax:505-892-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0713174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMA100865OtherMEDICARE PTAN