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Individual
MR. JUAN SANDOVAL
Active
Individual
MR. JUAN SANDOVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN087426
GA
163WA2000X
Administrator Registered Nurse
RN030419
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163W00000X
CONTRACT
GA
Enumeration date
04/12/2011
Last updated
04/12/2011
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