Healthcare Provider Details

I. General information

NPI: 1942554480
Provider Name (Legal Business Name): SANDYA SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 W PIERCE ST SUITE 5C
CARLSBAD NM
88220-3537
US

IV. Provider business mailing address

2402 W PIERCE ST SUITE 5C
CARLSBAD NM
88220-3537
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5755
  • Fax:
Mailing address:
  • Phone: 575-725-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number20020399
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2002-0399
License Number StateNM

VIII. Authorized Official

Name: DR. MURUGAN ATHIGAMAN
Title or Position: OWNER
Credential: M.D.
Phone: 575-725-5755