Healthcare Provider Details

I. General information

NPI: 1740374354
Provider Name (Legal Business Name): SANDRA LUZ NEVAREZ-BALDERRAMA NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/19/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N OREGON
EL PASO TX
79912
US

IV. Provider business mailing address

600 VILLA PLACE
EL PASO TX
79907
US

V. Phone/Fax

Practice location:
  • Phone: 915-577-6640
  • Fax:
Mailing address:
  • Phone: 915-887-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number510093
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number101-0134318
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP113775
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: