Healthcare Provider Details

I. General information

NPI: 1174486682
Provider Name (Legal Business Name): ALFREDA JARUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S 9TH ST
INDIANOLA IA
50125-2824
US

IV. Provider business mailing address

277 E AMADOR AVE STE 101
LAS CRUCES NM
88001-3675
US

V. Phone/Fax

Practice location:
  • Phone: 515-335-8177
  • Fax:
Mailing address:
  • Phone: 505-392-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: