Healthcare Provider Details

I. General information

NPI: 1487163929
Provider Name (Legal Business Name): MS. CASEY LARA FIGUEREDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE STE 201
ALBUQUERQUE NM
87109-2128
US

IV. Provider business mailing address

101 HOSPITAL LOOP NE STE 201
ALBUQUERQUE NM
87109-2128
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-4430
  • Fax:
Mailing address:
  • Phone: 505-727-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2024-0128
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberF263-1129-7639
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: