Healthcare Provider Details

I. General information

NPI: 1679424493
Provider Name (Legal Business Name): EDWARD H ALDERETE JR. CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10309 SANDY CREEK RD SW
ALBUQUERQUE NM
87121-3633
US

IV. Provider business mailing address

10309 SANDY CREEK RD SW
ALBUQUERQUE NM
87121-3633
US

V. Phone/Fax

Practice location:
  • Phone: 505-544-0808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: