Provider Demographics
NPI:1326847344
Name:SANCHEZ, ROMAN BONIFACIO (CPSW, CCSS)
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:BONIFACIO
Last Name:SANCHEZ
Suffix:
Gender:
Credentials:CPSW, CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N RIVERSIDE DR STE 6
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2916
Mailing Address - Country:US
Mailing Address - Phone:505-367-3500
Mailing Address - Fax:505-367-3503
Practice Address - Street 1:908 N RIVERSIDE DR STE 6
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2916
Practice Address - Country:US
Practice Address - Phone:505-367-3500
Practice Address - Fax:505-367-3500
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
172V00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker