Healthcare Provider Details

I. General information

NPI: 1417798604
Provider Name (Legal Business Name): SARA JANELLE TAJIBOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 BROADBENT PKWY NE STE H
ALBUQUERQUE NM
87107-1618
US

IV. Provider business mailing address

6000 MONTANO PLAZA DR NW APT 13A
ALBUQUERQUE NM
87120-2473
US

V. Phone/Fax

Practice location:
  • Phone: 505-526-5562
  • Fax:
Mailing address:
  • Phone: 505-526-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: