MEDICARE: ALEXANDRA PENA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86116253	NM

General Provider Information

NPI Number	:	1881557536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA PENA

Provider Business Mailing Address
First Line	:	5411 MONTEREY COVE AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-2056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 SAN PEDRO DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5153
Country	:	US
Telephone Number	:	505-265-1711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ ALEXANDRA PENA ” Practice Location

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