Healthcare Provider Details

I. General information

NPI: 1760730923
Provider Name (Legal Business Name): JASINTA S SANCHEZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 BROADWAY BLVD SE
ALBUQUERQUE NM
87105-7469
US

IV. Provider business mailing address

10014 2ND ST NW TRLR 19
ALBUQUERQUE NM
87114-2257
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-5557
  • Fax:
Mailing address:
  • Phone: 505-312-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7269
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: