Healthcare Provider Details

I. General information

NPI: 1245385947
Provider Name (Legal Business Name): FARAZ SANDHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S SCHWARTZ AVE SUITE 201
FARMINGTON NM
87401-5954
US

IV. Provider business mailing address

PO BOX 844088
DALLAS TX
75284-4088
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6730
  • Fax: 505-609-6749
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2009-0600
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: