Healthcare Provider Details

I. General information

NPI: 1336728104
Provider Name (Legal Business Name): ADRIAN ALBERTO ANZALDUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 TUCKER AVENUE NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

524 SOLANO DR NE
ALBUQUERQUE NM
87108-1048
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2223
  • Fax:
Mailing address:
  • Phone: 254-717-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2025-0633
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: