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General NPI Number Information
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NPI Number | 1720668726
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Entity Type | Individual
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Provider Name | ALEXANDRA MANG
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Gender | Female
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 10/12/2025
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Provider Practice Location Address
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Address Line | 2211 LOMAS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2719
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Country | US
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Telephone | 505-272-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 13001 ROMA AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1635
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Country | US
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Telephone | 505-412-0120
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | RS2021-0590
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License Number State | NM
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