Provider Demographics
NPI:1003117698
Name:SANCHEZ, ADOLFO VIVIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:VIVIAN
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 SOUTH CHRISTOPHER ROAD
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-2617
Mailing Address - Country:US
Mailing Address - Phone:505-864-7781
Mailing Address - Fax:505-864-3360
Practice Address - Street 1:703 SOUTH CHRISTOPHER ROAD
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-2617
Practice Address - Country:US
Practice Address - Phone:505-864-7781
Practice Address - Fax:505-864-3360
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82959374Medicaid
NMNMAAA1394OtherMEDICARE INDIVIDUAL PTAN