Healthcare Provider Details

I. General information

NPI: 1881089894
Provider Name (Legal Business Name): SANDIA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 JUAN TABO BLVD NE SUITE 1E
ALBUQUERQUE NM
87111-2683
US

IV. Provider business mailing address

5203 JUAN TABO BLVD NE SUITE 1B
ALBUQUERQUE NM
87111-2683
US

V. Phone/Fax

Practice location:
  • Phone: 505-369-0066
  • Fax:
Mailing address:
  • Phone: 505-369-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNM

VIII. Authorized Official

Name: MRS. ROBIN CHAVEZ
Title or Position: MANAGER
Credential:
Phone: 505-369-0066