Healthcare Provider Details

I. General information

NPI: 1225150535
Provider Name (Legal Business Name): SANDIA PHS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 SANDIA LOOP
BERNALILLO NM
87004-7076
US

IV. Provider business mailing address

481 SANDIA LOOP
BERNALILLO NM
87004-7076
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-4028
  • Fax:
Mailing address:
  • Phone: 505-248-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PEDRO SOLIS
Title or Position: PHARMACY DIRECTOR, ACTING
Credential: PHARM.D.
Phone: 505-248-4028