Provider Demographics
NPI:1306235304
Name:SFAKIANOS, ALEXANDER GEORGE
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GEORGE
Last Name:SFAKIANOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PUEBLO SOLANO RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6131
Mailing Address - Country:US
Mailing Address - Phone:505-314-3173
Mailing Address - Fax:
Practice Address - Street 1:315 PUEBLO SOLANO RD NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6131
Practice Address - Country:US
Practice Address - Phone:505-314-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist