Healthcare Provider Details

I. General information

NPI: 1003627779
Provider Name (Legal Business Name): ALONDRA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 CAJA DEL ORO GRANT RD
SANTA FE NM
87507-3279
US

IV. Provider business mailing address

PO BOX 5395
SANTA FE NM
87502-5395
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4425
  • Fax: 505-982-1263
Mailing address:
  • Phone: 505-982-4425
  • Fax: 505-982-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number53-014
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: