Provider Demographics
NPI:1285201327
Name:ANDRADE, DAVID ALEJANDRO (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALEJANDRO
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCS09 5030 1 UNIVERSITY OF NEW MEXICO, DEPARTMENT OF PS
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131
Mailing Address - Country:US
Mailing Address - Phone:505-272-5428
Mailing Address - Fax:505-272-4639
Practice Address - Street 1:MCS09 5030 1 UNIVERSITY OF NEW MEXICO, DEPARTMENT OF PS
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-5428
Practice Address - Fax:505-272-4639
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2023-01-13
Deactivation Date:2022-12-01
Deactivation Code:
Reactivation Date:2023-01-13
Provider Licenses
StateLicense IDTaxonomies
390200000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program