Provider Demographics
NPI:1942554480
Name:SANDYA SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:SANDYA SURGICAL ASSOCIATES
Other - Org Name:SANDYA SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MURUGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATHIGAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-725-5755
Mailing Address - Street 1:2402 W PIERCE ST
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3537
Mailing Address - Country:US
Mailing Address - Phone:575-725-5755
Mailing Address - Fax:
Practice Address - Street 1:2402 W PIERCE ST
Practice Address - Street 2:SUITE 5C
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3537
Practice Address - Country:US
Practice Address - Phone:575-725-5755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0399208600000X
NM200203992086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty