Most Relevant Information
Provider Data
| NPI Number: | 1003371824 |
| Provider Name: | JESSE XUAN LIECHTY |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/06/2019 |
| Last Updated: | 09/18/2023 |
Provider Practice Location
1 UNIVERSITY BLVD
ALBUQUERQUE
NM
871310001
Practice Location Phone/Fax
| Phone: | 5059275191 |
| Fax: |
Provider Mailing Location
51 OJITO DR
ESPANOLA
NM
875329429
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |