Healthcare Provider Details

I. General information

NPI: 1043295710
Provider Name (Legal Business Name): ALEXANDRA CVIJANOVICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 N DATE ST
TRUTH OR CONSEQUENCES NM
87901-3701
US

IV. Provider business mailing address

PO BOX 370 255 HIGHWAY 187
HATCH NM
87937-0370
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-8057
  • Fax: 575-267-1747
Mailing address:
  • Phone: 575-267-3280
  • Fax: 575-267-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2005-0547
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: