Healthcare Provider Details

I. General information

NPI: 1952657678
Provider Name (Legal Business Name): SANDIA NATIONAL LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK BLVD SE BLDG 831832
ALBUQUERQUE NM
87123-3453
US

IV. Provider business mailing address

1515 EUBANK BLVD SE BLDG 831832
ALBUQUERQUE NM
87123-3453
US

V. Phone/Fax

Practice location:
  • Phone: 505-844-4237
  • Fax:
Mailing address:
  • Phone: 505-844-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TOMAS MAESTAS VALDEZ
Title or Position: PARAMEDIC
Credential: EMT-P
Phone: 505-845-8159