Healthcare Provider Details

I. General information

NPI: 1518513563
Provider Name (Legal Business Name): MILTON SANCHEZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CERRILLOS RD
SANTA FE NM
87505-3521
US

IV. Provider business mailing address

1501 CERRILLOS RD
SANTA FE NM
87505-3521
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-6300
  • Fax: 505-212-0576
Mailing address:
  • Phone: 505-989-6300
  • Fax: 505-212-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-10881
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: