VANESSA D LICONA SANJUAN (NPI# 1386958825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386958825 |
| Entity Type | Individual |
| Full Name | VANESSA D LICONA SANJUAN |
| Credential | MD |
| Practice Address |
500 Walter St Ne Ste 401 Albuquerque NM 87102-2563 |
| Practice Telephone | 5057275910 |
| Practice Fax Number | 5057275939 |
| Mailing Telephone | 5057275910 |
| Mailing Fax Number | 5057275939 |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2017-04-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD2012-0867 | NM | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 98305522 | 05 |
| Street Address |
500 WALTER ST NE STE 401 |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87102-2563 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326044512 | Infectious Diseases and Internal Medicine | Specialist | 500 Walter St Ne, Ste 104, Albuquerque, NM 87102-2541 | 2005-06-22 |
| 1154714921 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 500 Walter St Ne, Ste 202, Albuquerque, NM 87102-2543 | 2015-03-18 |
| 1073929238 | Stacy Pleasant | Nurse Practitioner | 500 Walter St Ne, Suite 401, Albuquerque, NM 87102-2534 | 2014-07-09 |
| 1770826810 | Ludmila Tsigelnitska | Nurse Practitioner | 500 Walter St Ne, Suite 401, Albuquerque, NM 87102-2534 | 2013-03-27 |
| 1942546411 | Cesar Gonzales | Pharmacist | 500 Walter St Ne, Suite 309, Albuquerque, NM 87102-2534 | 2013-01-02 |
| 1285979575 | Pamela Kay Wigal | Pharmacist | 500 Walter St Ne, Suite 309, Albuquerque, NM 87102-2534 | 2012-11-28 |
| 1780935544 | Sam Sanchez Jr. | Pharmacist | 500 Walter St Ne, Albuquerque, NM 87102-2534 | 2012-09-19 |
| 1457614471 | Koren Elizabeth Saiers | Physical Therapist | 500 Walter St Ne, P.t. Dept, Suite 310, Albuquerque, NM 87102-2534 | 2012-06-25 |
| 1619239670 | Akash K Attreya | Family Medicine | 500 Walter St Ne, Albuquerque, NM 87102-2534 | 2012-06-14 |
| 1518264308 | Aleksandr Tsigelnitskiy | Nurse Practitioner | 500 Walter St Ne, Suite 401, Albuquerque, NM 87102-2534 | 2011-02-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454937 | Julie Wood | Acupuncturist | 1600 Luna Circle Nw, Albuquerque, NM 87102 | 2020-10-16 |
| 1770121410 | Emily Perez | Counselor | 218 Broadway Ne, Albuquerque, NM 87102 | 2019-12-12 |
| 1417503392 | Tess Holtry | Behavior Technician | 1424 Walter St Nw, Albuquerque, NM 87102 | 2019-08-15 |
| 1942867486 | Christy E Cheromiah | Behavioral Analyst | Open Skies Helathcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-05-21 |
| 1730744103 | Faith Petra Maxwell | Behavior Technician | 900 Arno St, Albuquerque, NM 87102 | 2019-05-01 |
| 1568923761 | Storm Swinford | Behavioral Analyst | Open Skies Healthcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-29 |
| 1093276651 | Tina Marie Trujillo | Behavioral Analyst | Open Skies Health Care, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-27 |
| 1861950370 | Meghan Montoya | Student in an Organized Health Care Education/Training Program | 801 Camino De Salud, Albuquerque, NM 87102 | 2019-03-05 |
| 1174099329 | Dilshani N Tyson | Counselor | 600 1st Street Nw Ste 200, Albuquerque, NM 87102 | 2018-10-15 |
| 1962987925 | Tania L Goldfeder | Social Worker | New Mexico Solutions, 707 Broadway Ne Suite 500, Albuquerque, NM 87102 | 2018-09-26 |
| Find all providers in zip 87102 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083841399 | Elizabeth M Macri | Psychiatry & Neurology | 2211 Lomas Blvd Ne Unm-neurology Msc10 5620, Albuquerque, NM 87131-3011 | 2009-06-12 |
| 1417193459 | Semiramis Youssof | Psychiatry & Neurology | Msc 10 5620, Albuquerque, NM 87131-0001 | 2008-12-22 |
| 1831355106 | Matthew Todd Starr | Psychiatry & Neurology | Department of Neurology Msc10 5620 Health Ctr, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2008-08-05 |
| 1457531022 | John A Campa IIi | Psychiatry & Neurology | 7520 Montgomery Blvd Ne Bldg E4, Albuquerque, NM 87109-1554 | 2007-11-12 |
| 1730381179 | Erik Burton | Psychiatry & Neurology | 1101 Yale Blvd Ne, Albuquerque, NM 87106-3834 | 2007-06-05 |
| 1487856431 | Kenneth Imerman | Psychiatry & Neurology | Department of Neurology Msc10 5620, Health Science Center, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2007-06-01 |
| 1124167135 | Baljinder S Sandhu | Psychiatry & Neurology | Pmg Cedar Neurology, 201 Cedar Se, Albuquerque, NM 87106 | 2007-02-06 |
| 1821137837 | Luzma Cardona | Psychiatry & Neurology | Unm Hospital Neurology, 2211 Lomas Blvd Ne, Albuquerque, NM 87131-0001 | 2007-02-06 |
| 1235297839 | Manuel A Gurule | Psychiatry & Neurology | 4273 Montgomery Ne, Suite 110, Albuquerque, NM 87109-6746 | 2006-12-05 |
| 1417041807 | Anna Y Vigil | Psychiatry & Neurology | 201 Cedar St Se Ste 5630, Pmg Cedar Neurology, Albuquerque, NM 87106-4920 | 2006-10-03 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87102 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.