Healthcare Provider Details

I. General information

NPI: 1780165936
Provider Name (Legal Business Name): RONEESHA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 08/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1715
US

IV. Provider business mailing address

5315 YUCCA CIR NW APT 27
ALBUQUERQUE NM
87120-1476
US

V. Phone/Fax

Practice location:
  • Phone: 505-386-0072
  • Fax:
Mailing address:
  • Phone: 505-386-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8190
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: