Provider Demographics
NPI:1699461251
Name:DAVIANO, ALEXJANDRO C (DN, DO, DRPH, MS,MPH)
Entity type:Individual
Prefix:DR
First Name:ALEXJANDRO
Middle Name:C
Last Name:DAVIANO
Suffix:
Gender:
Credentials:DN, DO, DRPH, MS,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BOTULPH RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5764
Mailing Address - Country:US
Mailing Address - Phone:806-478-7398
Mailing Address - Fax:
Practice Address - Street 1:811 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4466
Practice Address - Country:US
Practice Address - Phone:806-478-7398
Practice Address - Fax:575-616-7016
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5005487146L00000X
NMDN20240007172P00000X, 225400000X, 208100000X
174400000X, 1744R1102X, 174H00000X, 246Z00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No172P00000XOther Service ProvidersNaprapath
No174400000XOther Service ProvidersSpecialist
No1744R1102XOther Service ProvidersSpecialistResearch Study
No174H00000XOther Service ProvidersHealth Educator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program