Healthcare Provider Details

I. General information

NPI: 1093356214
Provider Name (Legal Business Name): SINA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 01/12/2020
Certification Date: 01/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 RIO COMMUNITIES BLVD
RIO COMMUNITIES NM
87002
US

IV. Provider business mailing address

PO BOX 94204
ALBUQUERQUE NM
87199-4204
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-2457
  • Fax:
Mailing address:
  • Phone: 505-916-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER ELIZABETH CHACON
Title or Position: ASSISTANT
Credential:
Phone: 505-688-1306