Provider Demographics
NPI:1720469034
Name:ALLER, MINDY
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:ALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-0072
Mailing Address - Country:US
Mailing Address - Phone:505-818-5769
Mailing Address - Fax:
Practice Address - Street 1:5 SNOW PL
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-0072
Practice Address - Country:US
Practice Address - Phone:505-818-5769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM50926853Medicaid