Healthcare Provider Details

I. General information

NPI: 1427703404
Provider Name (Legal Business Name): ALMA ROSA JURADO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 DENNIS CHAVEZ BLVD SW
ALBUQUERQUE NM
87121-5498
US

IV. Provider business mailing address

10800 DENNIS CHAVEZ BLVD SW
ALBUQUERQUE NM
87121-5498
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6009
  • Fax:
Mailing address:
  • Phone: 505-272-6009
  • Fax: 505-272-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2022-0134
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: