Healthcare Provider Details

I. General information

NPI: 1912594060
Provider Name (Legal Business Name): ROLAND K SANCHEZ MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 01/26/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 SOUTH CHRISTOPHER ROAD
BELEN NM
87002
US

IV. Provider business mailing address

703 SOUTH CHRISTOPHER ROAD
BELEN NM
87002
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 Number
License Number State

VIII. Authorized Official

Name: ELIA F SANCHEZ
Title or Position: OWNER
Credential:
Phone: 505-864-7781