Provider Demographics
NPI:1538101076
Name:SANCHEZ, MELISSA JONGCO (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JONGCO
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 INDIAN SCHOOL RD, NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-265-7817
Mailing Address - Fax:505-266-1543
Practice Address - Street 1:3410 INDIAN SCHOOL RD, NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-265-7817
Practice Address - Fax:505-266-1543
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0254208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8840300Medicaid
NM76938565Medicaid