Organization
MEDESTED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SANCHEZ (PRINCIPAL)
(505) 261-5219
Entity
Organization
Contact information
Practice address
2900 LOUISIANA BLVD NE, SUITE B1, ALBUQUERQUE, NM 87110-3532
(505) 881-6337
Mailing address
2900 LOUISIANA BLVD NE, SUITE B1, ALBUQUERQUE, NM 87110-3532
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
4665520
NM
Other
Enumeration date
11/05/2012
Last updated
11/05/2012
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