# PETER SANGRA MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306464615
- **Authorized official:** PETER SANGRA MD (OWNER)
- **Authorized official phone:** (404) 513-2350

## Contact information

- **Practice address:** 5055 MCNUTT RD, SANTA TERESA, NM 88008-9442
- **Practice address phone:** (575) 589-3000
- **Mailing address:** 2004 BOY SCOUT LN, SUNLAND PARK, NM 88063-9500
- **Mailing address phone:** (404) 513-2350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2020
- **Last updated:** 07/13/2020