Healthcare Provider Details

I. General information

NPI: 1144603069
Provider Name (Legal Business Name): ALEX MARIE YRAGUI M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 HOSPITAL DR BUILDING B, SUITE 101
SANTA FE NM
87505-4754
US

IV. Provider business mailing address

1633 CAMINO LA CANADA
SANTA FE NM
87501-2324
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-2560
  • Fax: 505-989-3841
Mailing address:
  • Phone: 949-751-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC2015-013
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: