Healthcare Provider Details

I. General information

NPI: 1306336649
Provider Name (Legal Business Name): SIDNEY SANFORD CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 09/11/2025
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

4885 N WHISPER WOOD DR
LEHI UT
84043-6576
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax:
Mailing address:
  • Phone: 801-897-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA2018-003
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: