Basic Information
Provider Information
NPI: 1720303035
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANCHEZ
FirstName: JOHN
MiddleName: P
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 933 BRADBURY DR SE STE 2222
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871064375
CountryCode: US
TelephoneNumber: 5052723120
FaxNumber:  
Practice Location
Address1: 1 UNIVERSITY OF NEW MEXICO MSC 11-6025
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871310001
CountryCode: US
TelephoneNumber: 5052725062
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/30/2010
LastUpdateDate: 07/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X251375NYN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000XMD2020-0358NMY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


Home