Healthcare Provider Details

I. General information

NPI: 1740514603
Provider Name (Legal Business Name): SABRINA S. MAYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 BARBARA LOOP SE
RIO RANCHO NM
87124-1000
US

IV. Provider business mailing address

4501 ASPEN GLADE DR NW
ALBUQUERQUE NM
87114-5444
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-8547
  • Fax:
Mailing address:
  • Phone: 505-507-7449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10440
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: