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General NPI Number Information
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NPI Number | 1548588643
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Entity Type | Organization
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Legal Business Name | PUEBLO OF SANDIA
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 203 SANDIA DAY SCHOOL ROAD
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City | BERNALILLO
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State | NM
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Zip | 87004-7076
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Country | US
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Telephone | 505-867-4696
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Fax | 505-771-5107
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Provider Business Mailing Address
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Address Line | 481 SANDIA LOOP
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City | BERNALILLO
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State | NM
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Zip | 87004-7076
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Country | US
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Telephone | 505-867-4696
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Fax | 505-867-4997
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MS. GWENDOLYN WASETA
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Credential |
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Telephone | 505-771-5174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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