Healthcare Provider Details

I. General information

NPI: 1154021152
Provider Name (Legal Business Name): ALEXANDER CUNNINGHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 RODEO RD
SANTA FE NM
87505-6816
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 505-982-2129
  • Fax:
Mailing address:
  • Phone: 866-273-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCTB-2024-0778
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: