Healthcare Provider Details

I. General information

NPI: 1710502117
Provider Name (Legal Business Name): ALEJANDRO SALCIDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 E BELL RD STE 104
PHOENIX AZ
85022-6641
US

IV. Provider business mailing address

9640 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2217
US

V. Phone/Fax

Practice location:
  • Phone: 602-717-0916
  • Fax:
Mailing address:
  • Phone: 505-294-4167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number60363
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: