Healthcare Provider Details

I. General information

NPI: 1497421820
Provider Name (Legal Business Name): NORBERT JAY SANIDAD CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NORBERT JAY SANIDAD APRN

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 02/12/2025
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

500 WALTER ST NE STE 110
ALBUQUERQUE NM
87102-2541
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-6124
  • Fax:
Mailing address:
  • Phone: 505-727-8360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number65109
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: