Healthcare Provider Details

I. General information

NPI: 1639598824
Provider Name (Legal Business Name): SANDRA ELIZABETH ALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA ELIZABETH CANTU MD

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ENTERPRISE RD
SOCORRO NM
87801-0001
US

IV. Provider business mailing address

933 BRADBURY DR SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-4444
  • Fax: 575-835-1010
Mailing address:
  • Phone: 505-272-3120
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2017-0163
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: