MEDICARE: TINA MARIE SANCHEZ LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	I-08246	NM

General Provider Information

NPI Number	:	1689090425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA MARIE SANCHEZ LISW

Provider Business Mailing Address
First Line	:	1909 CHAMISA ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 CHAMISA ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3439
Country	:	US
Telephone Number	:	505-750-4684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	09/22/2022

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