Healthcare Provider Details

I. General information

NPI: 1902921182
Provider Name (Legal Business Name): ROLAND KENT SANCHEZ, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/06/2010
Certification Date:
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 TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROLAND KENT SANCHEZ
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 505-864-7781