Provider Demographics
NPI:1114355039
Name:SAMPAIO, BIANCA (DOM)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:SAMPAIO
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SAINT MICHAELS DR STE 601
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7652
Mailing Address - Country:US
Mailing Address - Phone:505-984-3034
Mailing Address - Fax:505-984-3034
Practice Address - Street 1:460 SAINT MICHAELS DR STE 601
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7652
Practice Address - Country:US
Practice Address - Phone:505-984-3034
Practice Address - Fax:505-984-3034
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1122171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist