Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD2010-0579 | NM |
NPI | 1003117698 |
---|---|
Provider Name | Dr. Adolfo Vivian Sanchez |
First Address | Belen, NM 87002-2617 |
Second Address | Belen, NM 87002-2617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2010 |
Last Update Date | 27/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
82959374 | (05) | NM |
NMAAA1394 | MEDICARE INDIVIDUAL PTAN (01) | NM |