Provider Demographics
NPI:1538324215
Name:MENA GUTIERREZ, ALEJANDRA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:MARIA
Last Name:MENA GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 BARSTOW ST NE APT 16101
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2883
Mailing Address - Country:US
Mailing Address - Phone:859-539-2640
Mailing Address - Fax:
Practice Address - Street 1:401 SAN MATEO BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2921
Practice Address - Country:US
Practice Address - Phone:505-462-7333
Practice Address - Fax:505-462-7440
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0053207R00000X
KYR1559207R00000X
NC2018-01691207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine