Healthcare Provider Details

I. General information

NPI: 1114884541
Provider Name (Legal Business Name): MICHAEL ANGELO SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 WYATT DR STE 9
LAS CRUCES NM
88005-2962
US

IV. Provider business mailing address

900 E MADRID AVE TRLR 29
LAS CRUCES NM
88001-1941
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1672
  • Fax:
Mailing address:
  • Phone: 575-288-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: