Healthcare Provider Details

I. General information

NPI: 1568708980
Provider Name (Legal Business Name): SANDIA STAFFING ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK BLVD SE MS 1019
ALBUQUERQUE NM
87123-3453
US

IV. Provider business mailing address

1515 EUBANK BLVD SE MS 1019
ALBUQUERQUE NM
87123-3453
US

V. Phone/Fax

Practice location:
  • Phone: 505-845-8159
  • Fax: 505-845-8667
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number762533
License Number StateTX

VIII. Authorized Official

Name: DANIELLE M BEESLEY
Title or Position: RN
Credential:
Phone: 505-845-8519