Healthcare Provider Details

I. General information

NPI: 1659126985
Provider Name (Legal Business Name): ASTRIA ALEXANDRIA RAYMOS LSAA, CCSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDER EDWARD RAMOS

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CARLISLE BLVD NE APT J6
ALBUQUERQUE NM
87109-1060
US

IV. Provider business mailing address

4601 CARLISLE BLVD NE APT J6
ALBUQUERQUE NM
87109-1060
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-2040
  • Fax: 505-916-2040
Mailing address:
  • Phone: 505-274-0707
  • Fax: 505-274-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2024-0271
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: