Healthcare Provider Details

I. General information

NPI: 1205723442
Provider Name (Legal Business Name): MR. MARK JOSEPH ALVARADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF NEW MEXICO ALBUQUERQUE NM 87131
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

UNIVERSITY OF NEW MEXICO ALBUQUERQUE NM 87131
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-9864
  • Fax:
Mailing address:
  • Phone: 505-272-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2026-0008
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: