Healthcare Provider Details

I. General information

NPI: 1699166140
Provider Name (Legal Business Name): SANDIA NATIONAL LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK BLVD SE BLDG. 831/832
ALBUQUERQUE NM
87185-1019
US

IV. Provider business mailing address

1515 EUBANK BLVD SE BLDG. 831/832
ALBUQUERQUE NM
87185-1019
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL HOMMERT
Title or Position: PRESIDENT
Credential:
Phone: 505-844-7261