Healthcare Provider Details

I. General information

NPI: 1538807979
Provider Name (Legal Business Name): ALEJANDRO FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX FERNANDEZ

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSUNA RD NE STE 600
ALBUQUERQUE NM
87113-0009
US

IV. Provider business mailing address

701 OSUNA RD NE STE 600
ALBUQUERQUE NM
87113-0009
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-2369
  • Fax: 505-508-2523
Mailing address:
  • Phone: 505-508-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: