Healthcare Provider Details

I. General information

NPI: 1336955863
Provider Name (Legal Business Name): ALEXANDRA MALKOSKI
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: ALEX MALKOSKI

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 VENICE AVE NE STE A
ALBUQUERQUE NM
87113-2337
US

IV. Provider business mailing address

5201 VENICE AVE NE STE A
ALBUQUERQUE NM
87113-2337
US

V. Phone/Fax

Practice location:
  • Phone: 505-796-6367
  • Fax:
Mailing address:
  • Phone: 505-796-6367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: