Licona Sanjuan, Vanessa D
Licona Sanjuan, Vanessa D is an individual health care provider with primary practice located at 500 Walter St Ne Ste 401, Albuquerque NM 87102-2563. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Neurology is her primary health care specialty. Licona Sanjuan, Vanessa D can be contacted via phone (505) 727-5910.Contact Information
Primary practice address
500 Walter St Ne Ste 401
Albuquerque NM 87102-2563
Phone: (505) 727-5910
Fax: (505) 727-5939
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | MD2012-0867 | New Mexico |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X |
Profile Details
| NPI number | 1386958825 |
|---|---|
| LBN Legal business name | Licona Sanjuan, Vanessa D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 26th, 2010 |
| Last updated | Apr 19th, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386958825 | NPPES |
| New Mexico | MEDICAID | 98305522 |
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