Healthcare Provider Details

I. General information

NPI: 1750069803
Provider Name (Legal Business Name): SABRINA VIZCAINO MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 WYOMING BLVD NE STE 5
ALBUQUERQUE NM
87109-3132
US

IV. Provider business mailing address

7517 RICHMOND HILL RD NW
ALBUQUERQUE NM
87120-4553
US

V. Phone/Fax

Practice location:
  • Phone: 505-803-6208
  • Fax:
Mailing address:
  • Phone: 505-803-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT8776
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: