1528624426 NPI number — ALESSANDRA DESIREE DALLERA NAPRAPATHIC DOCTOR

Table of content: ALESSANDRA DESIREE DALLERA NAPRAPATHIC DOCTOR (NPI 1528624426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528624426 NPI number — ALESSANDRA DESIREE DALLERA NAPRAPATHIC DOCTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALLERA
Provider First Name:
ALESSANDRA
Provider Middle Name:
DESIREE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NAPRAPATHIC DOCTOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALLERA
Provider Other First Name:
ALESSANDRA
Provider Other Middle Name:
DESIREE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528624426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1640 JAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-3893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-913-9323
Provider Business Mailing Address Fax Number:
505-992-0077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 JAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-3893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-913-9323
Provider Business Practice Location Address Fax Number:
505-992-0077
Provider Enumeration Date:
05/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172P00000X , with the licence number:  01025 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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