Healthcare Provider Details

I. General information

NPI: 1366893695
Provider Name (Legal Business Name): ALEXIS RICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 ACADEMY RD NE BLD 2 SUITE 200
ALBUQUERQUE NM
87109-3379
US

IV. Provider business mailing address

7801 ACADEMY RD NE BLD 2 SUITE 200
ALBUQUERQUE NM
87109-3379
US

V. Phone/Fax

Practice location:
  • Phone: 505-273-6300
  • Fax:
Mailing address:
  • Phone: 505-273-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: