Healthcare Provider Details

I. General information

NPI: 1912772971
Provider Name (Legal Business Name): ADRIANNA TEJEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 W 21ST ST
CLOVIS NM
88101-4199
US

IV. Provider business mailing address

1211 8TH ST STE C
ALAMOGORDO NM
88310-5808
US

V. Phone/Fax

Practice location:
  • Phone: 866-273-2451
  • Fax:
Mailing address:
  • Phone: 866-273-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: