Individual
MARIO ERNESTO HENRIQUEZ ALVARENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3630 LAS ESTANCIAS DR SW, ALBUQUERQUE, NM 87121-5504
(505) 462-7777
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(806) 723-6532
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD20160227
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972941813
BCBS
NM
05
—
1972941813
—
NM
01
—
1K8582
MEDICARE
NM
Enumeration date
06/13/2013
Last updated
04/27/2021
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