Healthcare Provider Details

I. General information

NPI: 1003117698
Provider Name (Legal Business Name): ADOLFO VIVIAN SANCHEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 01/27/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 SOUTH CHRISTOPHER ROAD
BELEN NM
87002-2617
US

IV. Provider business mailing address

703 SOUTH CHRISTOPHER ROAD
BELEN NM
87002-2617
US

V. Phone/Fax

Practice location:
  • Phone: 505-864-7781
  • Fax: 505-864-3360
Mailing address:
  • Phone: 505-864-7781
  • Fax: 505-864-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2010-0579
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: