Healthcare Provider Details

I. General information

NPI: 1699366328
Provider Name (Legal Business Name): ALEXANDRE ROBERT PERRIN CNY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 02/12/2025
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 MARBLE AVE
ALBUQUERQUE NM
87131-2727
US

IV. Provider business mailing address

2502 MARBLE AVE
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 800-690-0934
  • Fax:
Mailing address:
  • Phone: 800-690-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number64488
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: