Provider Demographics
NPI:1053130906
Name:YNIGUEZ, SANDRA TERESEA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:TERESEA
Last Name:YNIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2437
Mailing Address - Country:US
Mailing Address - Phone:562-417-8778
Mailing Address - Fax:
Practice Address - Street 1:1625 BIRCH CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2437
Practice Address - Country:US
Practice Address - Phone:562-417-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH21463183700000X
NMPT00016739183700000X
IN67043583A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician