Healthcare Provider Details

I. General information

NPI: 1508712076
Provider Name (Legal Business Name): ALYSHIA ANGEL MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6109 MONTE AZUL PL
SANTA FE NM
87507-1304
US

IV. Provider business mailing address

HC 74 BOX 454
PECOS NM
87552-9503
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-4599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: