Healthcare Provider Details

I. General information

NPI: 1629628813
Provider Name (Legal Business Name): ADRIANA VIZCAINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

IV. Provider business mailing address

12284 MANKATO RD
CLINT TX
79836-4800
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 808-344-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP142643
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number80189
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: