Healthcare Provider Details

I. General information

NPI: 1275860942
Provider Name (Legal Business Name): MELBA REGINA SANCHEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 PASEO DE PERALTA
SANTA FE NM
87501-4391
US

IV. Provider business mailing address

1756 AVENIDA LOS GRIEGOS NW
ALBUQUERQUE NM
87107-3449
US

V. Phone/Fax

Practice location:
  • Phone: 505-514-5844
  • Fax:
Mailing address:
  • Phone: 505-514-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-07963
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: