Healthcare Provider Details

I. General information

NPI: 1104636158
Provider Name (Legal Business Name): SANDIA HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4313
US

IV. Provider business mailing address

3301 COORS BLVD NW STE R230
ALBUQUERQUE NM
87120-1292
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-2741
  • Fax: 505-631-0633
Mailing address:
  • Phone: 505-226-2741
  • Fax: 505-631-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VERONICA GABALDON
Title or Position: MANAGER
Credential:
Phone: 505-226-2741