Healthcare Provider Details

I. General information

NPI: 1447175294
Provider Name (Legal Business Name): MIREYA DESTINY JURADO CCHW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 ALAMO AVE SE STE 200
ALBUQUERQUE NM
87106-3225
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO # 74250
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-313-9942
  • Fax:
Mailing address:
  • Phone: 505-272-7258
  • Fax:

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: