Provider Demographics
NPI:1316099765
Name:SANCHEZ, ROIBALA L (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROIBALA
Middle Name:L
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:VELARDE
Mailing Address - State:NM
Mailing Address - Zip Code:87582-0009
Mailing Address - Country:US
Mailing Address - Phone:505-920-9710
Mailing Address - Fax:
Practice Address - Street 1:HWY 68 CR 41 RD 1045 HS 45
Practice Address - Street 2:
Practice Address - City:VELARDE
Practice Address - State:NM
Practice Address - Zip Code:87582-0009
Practice Address - Country:US
Practice Address - Phone:505-920-9710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34659714Medicaid