Healthcare Provider Details

I. General information

NPI: 1730900812
Provider Name (Legal Business Name): DAVID SANABRIA CHW/R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 3338
TOHAJIILEE NM
87026-3338
US

IV. Provider business mailing address

3425 OASIS SPRINGS RD NE
RIO RANCHO NM
87144-2582
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-2307
  • Fax:
Mailing address:
  • Phone: 505-659-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-1618
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: