Provider Demographics
NPI:1518045657
Name:NEW MEXICO PLASTIC
Entity Type:Organization
Organization Name:NEW MEXICO PLASTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SAKURA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:505-842-6868
Mailing Address - Street 1:1020 TIJERAS AVE NE STE 16
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4749
Mailing Address - Country:US
Mailing Address - Phone:505-842-6868
Mailing Address - Fax:505-842-9325
Practice Address - Street 1:1020 TIJERAS AVE NE STE 16
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4749
Practice Address - Country:US
Practice Address - Phone:505-842-6868
Practice Address - Fax:505-842-9325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77-251208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty