Provider Demographics
NPI:1164894069
Name:SANJUAN, PILAR (PHD)
Entity Type:Individual
Prefix:
First Name:PILAR
Middle Name:
Last Name:SANJUAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13204 COMANCHE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4315
Mailing Address - Country:US
Mailing Address - Phone:505-977-1082
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL
Practice Address - Street 2:MSC09 5030 1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-925-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1083103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist