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General NPI Number Information
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NPI Number | 1699669275
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Entity Type | Organization
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Legal Business Name | SANDIA MEDICAL GROUP
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 7050 BARSTOW ST NE STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-1056
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Country | US
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Telephone | 505-437-5085
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Fax |
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Provider Business Mailing Address
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Address Line | 7050 BARSTOW ST NE STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-1056
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Country | US
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Telephone | 505-437-5085
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Fax |
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Authorized Official
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Title or Position | OWNER & MEDICAL DIRECTOR
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Name | MRS. KATHRYN WHITE
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Credential |
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Telephone | 505-463-2691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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