Healthcare Provider Details

I. General information

NPI: 1467412676
Provider Name (Legal Business Name): SANDRA YAUK C PED
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 COORS BLVD NW
ALBUQUERQUE NM
87120-2785
US

IV. Provider business mailing address

6200 COORS BLVD NW
ALBUQUERQUE NM
87120-2785
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0533
  • Fax: 505-896-0522
Mailing address:
  • Phone: 505-896-0533
  • Fax: 505-896-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: