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General NPI Number Information
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NPI Number | 1235058272
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Entity Type | Individual
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Provider Name | STEWART DE JESUS STEWART
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Gender | Female
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/14/2026
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Provider Practice Location Address
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Address Line | 205 MOONGLOW AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310-3339
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Country | US
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Telephone | 575-434-4510
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Fax | 575-439-2314
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Provider Business Mailing Address
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Address Line | 17541 DIEGO AVE
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City | EL PASO
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State | TX
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Zip | 79938-8774
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Country | US
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Telephone | 915-317-9480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA4289
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License Number State | NM
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