Provider Demographics
NPI:1518338771
Name:NEZ, ANDRUW JARROD (LMT)
Entity Type:Individual
Prefix:
First Name:ANDRUW
Middle Name:JARROD
Last Name:NEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 WILLIAMSBURG RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4556
Mailing Address - Country:US
Mailing Address - Phone:505-355-8907
Mailing Address - Fax:
Practice Address - Street 1:2929 COORS BLVD NW STE 201A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1279
Practice Address - Country:US
Practice Address - Phone:505-355-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist