Individual
JOSE ALFREDO LAVADIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSW
Contact information
Practice address
203 CALIFONIA ST NE, ALBUQUERQUE, NM 87108
(505) 308-8296
Mailing address
203 CALIFONIA ST NE, ALBUQUERQUE, NM 87108
(505) 308-8296
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1089
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120484028
DRIVERS LICENCE
NM
Enumeration date
11/18/2020
Last updated
11/18/2020
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