Provider Demographics
NPI:1497421820
Name:SANIDAD, NORBERT (APRN)
Entity Type:Individual
Prefix:
First Name:NORBERT
Middle Name:
Last Name:SANIDAD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:NORBERT
Other - Middle Name:JAY
Other - Last Name:SANIDAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:500 WALTER ST NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2541
Mailing Address - Country:US
Mailing Address - Phone:505-727-8360
Mailing Address - Fax:
Practice Address - Street 1:601 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3619
Practice Address - Country:US
Practice Address - Phone:505-724-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM65109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily