Healthcare Provider Details

I. General information

NPI: 1407560071
Provider Name (Legal Business Name): SHERYL PANLILIO GUIAO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 ALTO ST
SANTA FE NM
87501-2406
US

IV. Provider business mailing address

4616 HOLIDAY BREEZE PL NE
ALBUQUERQUE NM
87111-2659
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4425
  • Fax: 505-982-8440
Mailing address:
  • Phone: 650-892-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH5605
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: