Healthcare Provider Details

I. General information

NPI: 1255455234
Provider Name (Legal Business Name): SANDIA HEALTH INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 EUBANK BLVD NE STE 18
ALBUQUERQUE NM
87111-3427
US

IV. Provider business mailing address

3900 EUBANK BLVD NE STE 18
ALBUQUERQUE NM
87111-3427
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-1585
  • Fax: 505-828-3901
Mailing address:
  • Phone: 505-881-1585
  • Fax: 505-828-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberNM287
License Number StateNM

VIII. Authorized Official

Name: DR. ANDY NGOC HO
Title or Position: PODIATRIST PRESIDENT
Credential: DPM
Phone: 505-217-4029