Healthcare Provider Details

I. General information

NPI: 1780541672
Provider Name (Legal Business Name): ALEXUS PADILLA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 CANDELARIA RD NE STE 250
ALBUQUERQUE NM
87107-1966
US

IV. Provider business mailing address

3321 CANDELARIA RD NE STE 250
ALBUQUERQUE NM
87107-1966
US

V. Phone/Fax

Practice location:
  • Phone: 505-358-0803
  • Fax:
Mailing address:
  • Phone: 505-358-0803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: