Healthcare Provider Details

I. General information

NPI: 1013740554
Provider Name (Legal Business Name): ALEXIS V DIORIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N BROADWAY ST
T OR C NM
87901-2834
US

IV. Provider business mailing address

312 N BROADWAY ST
TRUTH OR CONSEQUENCES NM
87901-2834
US

V. Phone/Fax

Practice location:
  • Phone: 575-297-0157
  • Fax:
Mailing address:
  • Phone: 575-297-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: