Healthcare Provider Details

I. General information

NPI: 1609834332
Provider Name (Legal Business Name): SALLY PECHSTEIN R.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 NOBLE LN
CORRALES NM
87048-7703
US

IV. Provider business mailing address

PO BOX 2980
CORRALES NM
87048-2980
US

V. Phone/Fax

Practice location:
  • Phone: 808-866-8142
  • Fax:
Mailing address:
  • Phone: 808-866-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT89872
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: