Healthcare Provider Details

I. General information

NPI: 1255297768
Provider Name (Legal Business Name): ALEJANDRO ARREDONDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 LEONARD ST SE
RIO RANCHO NM
87124-1644
US

IV. Provider business mailing address

3321 CANDELARIA RD NE
ALBUQUERQUE NM
87107-1966
US

V. Phone/Fax

Practice location:
  • Phone: 505-589-0017
  • Fax:
Mailing address:
  • Phone: 505-589-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: