Healthcare Provider Details

I. General information

NPI: 1629846829
Provider Name (Legal Business Name): YVETTE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 CANDELARIA RD NE STE J
ALBUQUERQUE NM
87107-1947
US

IV. Provider business mailing address

2 JANE LN
EDGEWOOD NM
87015-9526
US

V. Phone/Fax

Practice location:
  • Phone: 505-524-6000
  • Fax:
Mailing address:
  • Phone: 505-524-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0781
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: