Provider Demographics
NPI:1083078430
Name:SCHWARTZ, SARA KWAN
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:KWAN
Last Name:SCHWARTZ
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 1:169 TIERRA ENCANTADA
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-6811
Mailing Address - Country:US
Mailing Address - Phone:505-401-8322
Mailing Address - Fax:505-293-2952
Practice Address - Street 1:6727 ACADEMY RD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3369
Practice Address - Country:US
Practice Address - Phone:505-292-1818
Practice Address - Fax:505-293-2952
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0567207Q00000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program