Healthcare Provider Details

I. General information

NPI: 1285354555
Provider Name (Legal Business Name): ALEJANDRA OLIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 TEXAS ST NE
ALBUQUERQUE NM
87110-4684
US

IV. Provider business mailing address

548 CAROLINA DR
BERNALILLO NM
87004-6602
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-1871
  • Fax:
Mailing address:
  • Phone: 505-717-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: