Healthcare Provider Details

I. General information

NPI: 1639200918
Provider Name (Legal Business Name): SANDIA HEARING AIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E LOHMAN AVE STE. #134
LAS CRUCES NM
88001-3167
US

IV. Provider business mailing address

2001 E LOHMAN AVE STE. #134
LAS CRUCES NM
88001-3167
US

V. Phone/Fax

Practice location:
  • Phone: 505-523-0267
  • Fax: 505-523-6408
Mailing address:
  • Phone: 505-523-0267
  • Fax: 505-523-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number553
License Number StateNM

VIII. Authorized Official

Name: MS. PAULA CELESTE ROGERS
Title or Position: OFFICE MQNAGER
Credential: BC-HIS
Phone: 505-523-0267