Healthcare Provider Details

I. General information

NPI: 1992120695
Provider Name (Legal Business Name): MAGDELENA SANCHEZ DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 HOMESTEAD RD NE STE 202A
ALBUQUERQUE NM
87110-1524
US

IV. Provider business mailing address

PO BOX 94508 SUITE 106
ALBUQUERQUE NM
87199
US

V. Phone/Fax

Practice location:
  • Phone: 505-304-7228
  • Fax:
Mailing address:
  • Phone: 505-384-7352
  • Fax: 505-274-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1123
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: