Healthcare Provider Details

I. General information

NPI: 1922476084
Provider Name (Legal Business Name): INSIGHT EDUCATIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2155 CANDELERO ST
SANTA FE NM
87505-5649
US

IV. Provider business mailing address

1000 CORDOVA PL #402
SANTA FE NM
87505-1725
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-7511
  • Fax: 505-473-2812
Mailing address:
  • Phone: 505-471-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number206191
License Number StateNM

VIII. Authorized Official

Name: DR. ALEXANDRA KAY BAKOS
Title or Position: DIRECTOR
Credential: ED.D./PH.D
Phone: 505-577-7511