Healthcare Provider Details

I. General information

NPI: 1689320103
Provider Name (Legal Business Name): ANDREA MONDRAGON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 WIND RIDGE DR NW
ALBUQUERQUE NM
87120-3892
US

IV. Provider business mailing address

1612 WIND RIDGE DR NW
ALBUQUERQUE NM
87120-3892
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-1846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: