Healthcare Provider Details

I. General information

NPI: 1720244692
Provider Name (Legal Business Name): LARA J ALESSANDRELLI MS, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LARA J CIASULLI MS, CCC-A

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4318
US

IV. Provider business mailing address

2211 LOMAS BLVD. NE 5N
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-1670
  • Fax:
Mailing address:
  • Phone: 505-272-3535
  • Fax: 505-272-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number5476
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD5476
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: