Healthcare Provider Details

I. General information

NPI: 1235058272
Provider Name (Legal Business Name): STEWART DE JESUS STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MOONGLOW AVE
ALAMOGORDO NM
88310-3339
US

IV. Provider business mailing address

17541 DIEGO AVE
EL PASO TX
79938-8774
US

V. Phone/Fax

Practice location:
  • Phone: 575-434-4510
  • Fax: 575-439-2314
Mailing address:
  • Phone: 915-317-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA4289
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: