Healthcare Provider Details

I. General information

NPI: 1730989237
Provider Name (Legal Business Name): NASIELYS DRAGO
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: NASIE DRAGO

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE
ALBUQUERQUE NM
87112-1273
US

IV. Provider business mailing address

8605 CANYON RUN RD NE
ALBUQUERQUE NM
87111-6604
US

V. Phone/Fax

Practice location:
  • Phone: 505-710-1228
  • Fax:
Mailing address:
  • Phone: 505-710-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: