Healthcare Provider Details

I. General information

NPI: 1790484210
Provider Name (Legal Business Name): ALEXANDRIA LARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 PAN AMERICAN FWY NE STE D
ALBUQUERQUE NM
87107-4793
US

IV. Provider business mailing address

3530 PAN AMERICAN FWY NE STE D
ALBUQUERQUE NM
87107-4793
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-4469
  • Fax:
Mailing address:
  • Phone: 505-888-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: