Healthcare Provider Details

I. General information

NPI: 1609225184
Provider Name (Legal Business Name): STEPHANIE ALCARAZ-REZA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9388 VALLEY VIEW DR NW
ALBUQUERQUE NM
87114-4908
US

IV. Provider business mailing address

130 KOONTZ RD
CORRALES NM
87048-9002
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-8806
  • Fax:
Mailing address:
  • Phone: 314-517-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: