Healthcare Provider Details

I. General information

NPI: 1477108868
Provider Name (Legal Business Name): ALEXANDRA KRISTIANA ESQUIBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2019
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3952 SAN FELIPE RD
SANTA FE NM
87507-8073
US

IV. Provider business mailing address

2518 AGUA FRIA ST
SANTA FE NM
87505-6291
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-8575
  • Fax:
Mailing address:
  • Phone: 505-629-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB20240019
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: