Healthcare Provider Details

I. General information

NPI: 1194636365
Provider Name (Legal Business Name): SAMANTHA NANCY SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 SAN PEDRO DR NE BLDG C5
ALBUQUERQUE NM
87110-8906
US

IV. Provider business mailing address

5328 MONTGOMERY BLVD NE APT 4101
ALBUQUERQUE NM
87109-1360
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-4626
  • Fax:
Mailing address:
  • Phone: 505-440-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2024-0036
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: