Healthcare Provider Details

I. General information

NPI: 1316089931
Provider Name (Legal Business Name): MATTHEW LEE SANCHEZ D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 VASSAR PL NE
ALBUQUERQUE NM
87107-1869
US

IV. Provider business mailing address

7817 LOUISIANA BLVD NE UNIT 401
ALBUQUERQUE NM
87109-5640
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-0587
  • Fax:
Mailing address:
  • Phone: 505-797-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number744
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: