Healthcare Provider Details

I. General information

NPI: 1104851724
Provider Name (Legal Business Name): BETH M SANCHEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 MCLEOD RD NE SUITE L
ALBUQUERQUE NM
87109-2455
US

IV. Provider business mailing address

512 LAGUNA SECA LN NW
ALBUQUERQUE NM
87104-1777
US

V. Phone/Fax

Practice location:
  • Phone: 505-269-6339
  • Fax: 505-341-9487
Mailing address:
  • Phone: 505-269-6339
  • Fax: 505-345-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number726
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: