Healthcare Provider Details

I. General information

NPI: 1811456809
Provider Name (Legal Business Name): ALLISON C. STRADIOTTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W MAPLE ST STE E
FARMINGTON NM
87401-6589
US

IV. Provider business mailing address

8801 HORIZON BLVD NE STE 360
ALBUQUERQUE NM
87113-1563
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-4003
  • Fax: 505-327-6140
Mailing address:
  • Phone: 505-828-4923
  • Fax: 505-213-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2023-1170
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: