Healthcare Provider Details

I. General information

NPI: 1811379274
Provider Name (Legal Business Name): LUIS ANTONIO SARDINA PENA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 KASEMAN CT NE
ALBUQUERQUE NM
87110-7639
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-5850
  • Fax: 505-292-9724
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD2024-0810
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD2024-0810
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: