Healthcare Provider Details

I. General information

NPI: 1710989033
Provider Name (Legal Business Name): LILIBETH SANCHEZ-GESWALDO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DR MARTIN LUTHER KING JR AVE NE SUITE 301
ALBUQUERQUE NM
87102-3661
US

IV. Provider business mailing address

715 DR MARTIN LUTHER KING JR AVE NE SUITE 301
ALBUQUERQUE NM
87102-3661
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7281
  • Fax:
Mailing address:
  • Phone: 505-262-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA-1279-04
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: