MEDICARE: ASTRIA ALEXANDRIA RAYMOS LSAA, CCSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CTB-2024-0271	NM

General Provider Information

NPI Number	:	1659126985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASTRIA ALEXANDRIA RAYMOS LSAA, CCSS

Provider Business Mailing Address
First Line	:	4601 CARLISLE BLVD NE APT J6
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-1060
Country	:	US
Telephone Number	:	505-274-0707
Fax Number	:	505-274-0707

Provider Business Practice Location Address
First Line	:	4601 CARLISLE BLVD NE APT J6
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-1060
Country	:	US
Telephone Number	:	505-916-2040
Fax Number	:	505-916-2040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	03/06/2026

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