Healthcare Provider Details

I. General information

NPI: 1063573509
Provider Name (Legal Business Name): SANDIA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 SANDIA LOOP
BERNALILLO NM
87004-7076
US

IV. Provider business mailing address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-4487
  • Fax: 505-771-5126
Mailing address:
  • Phone: 505-248-7711
  • Fax: 505-248-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA RICKERT
Title or Position: CEO
Credential:
Phone: 505-248-4062