Healthcare Provider Details

I. General information

NPI: 1891380085
Provider Name (Legal Business Name): SANDIA FOOT & ANKLE OF ALBUQUERQUE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 02/29/2024
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CARMEL AVE NE STE 501
ALBUQUERQUE NM
87122-3125
US

IV. Provider business mailing address

8300 CARMEL AVE NE STE 501
ALBUQUERQUE NM
87122-3125
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1274
  • Fax: 505-717-1879
Mailing address:
  • Phone: 505-717-1274
  • Fax: 505-717-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARK TENNY
Title or Position: PRESIDENT
Credential: DPM
Phone: 505-717-1274