Healthcare Provider Details

I. General information

NPI: 1265094916
Provider Name (Legal Business Name): MARTIN MANUEL ALVARADO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

IV. Provider business mailing address

3900 EUBANK BLVD NE STE 12
ALBUQUERQUE NM
87111-3427
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-3344
  • Fax: 866-790-2292
Mailing address:
  • Phone: 505-884-3344
  • Fax: 866-790-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number56790
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: