Healthcare Provider Details

I. General information

NPI: 1134938814
Provider Name (Legal Business Name): DORA ESCOVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 LOMAS BLVD NW
ALBUQUERQUE NM
87102-1955
US

IV. Provider business mailing address

833 LOMAS BLVD NW
ALBUQUERQUE NM
87102-1955
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-7492
  • Fax: 505-422-4232
Mailing address:
  • Phone: 505-247-7492
  • Fax: 505-422-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: