Healthcare Provider Details

I. General information

NPI: 1083215735
Provider Name (Legal Business Name): AHECIO ALEXANDER LABRADA IZQUIERDO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2020
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 N 35TH AVE STE 1
PHOENIX AZ
85017-1496
US

IV. Provider business mailing address

6502 N 35TH AVE STE 1
PHOENIX AZ
85017-1496
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-5732
  • Fax: 602-314-4579
Mailing address:
  • Phone: 602-283-5732
  • Fax: 602-314-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number251902
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11010075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: