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General NPI Number Information
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NPI Number | 1881203156
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Entity Type | Individual
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Provider Name | ALBA SANJUAN SANJUAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 09/25/2022
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Provider Practice Location Address
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Address Line | 415 MORRIS ST STE 309
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City | CHARLESTON
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State | WV
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Zip | 25301
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Country | US
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Telephone | 304-388-3290
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Fax | 304-388-3186
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Provider Business Mailing Address
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Address Line | 415 MORRIS ST STE 309
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City | CHARLESTON
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State | WV
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Zip | 25301-1853
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Country | US
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Telephone | 304-388-3290
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Fax | 304-388-3186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 4352000978
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 31823
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License Number State | WV
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