Healthcare Provider Details

I. General information

NPI: 1558793158
Provider Name (Legal Business Name): DIEGO SANCHEZ CANDELAS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961 E. LOHMAN AVE. STE.34
LAS CRUCES NM
88011
US

IV. Provider business mailing address

3859 VAN ESS COURT
LAS CRUCES NM
88012
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-9960
  • Fax:
Mailing address:
  • Phone: 575-405-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number7181
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: