Healthcare Provider Details

I. General information

NPI: 1477286482
Provider Name (Legal Business Name): KENDY RODRIGUEZ SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N CALIFORNIA ST
SOCORRO NM
87801-4254
US

IV. Provider business mailing address

105 AVENUE A
ROSWELL NM
88203-8785
US

V. Phone/Fax

Practice location:
  • Phone: 575-626-2458
  • Fax:
Mailing address:
  • Phone: 575-626-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: