Healthcare Provider Details

I. General information

NPI: 1194302836
Provider Name (Legal Business Name): FRED ALEJANDRO LOOR JACHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GOLD AVE SW # 256
ALBUQUERQUE NM
87102-3335
US

IV. Provider business mailing address

MSC10 5550 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-359-0230
  • Fax:
Mailing address:
  • Phone: 505-272-4661
  • Fax: 505-272-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD2026-0486
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: