Healthcare Provider Details

I. General information

NPI: 1235264284
Provider Name (Legal Business Name): DERMATOLOGY & SKIN CANCER CENTER OF NM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4366
US

IV. Provider business mailing address

5120 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4366
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-7546
  • Fax: 505-243-7547
Mailing address:
  • Phone: 505-243-7546
  • Fax: 505-243-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA A CANGIOLOSI
Title or Position: EXECUTIVE VP OF OPERATIONS
Credential:
Phone: 505-243-7546