Individual
SANDY SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSW
Contact information
Practice address
12 UNSER BLVD SE STE C, RIO RANCHO, NM 87124-6300
(505) 636-6100
(505) 501-8646
Mailing address
12 UNSER BLVD SE STE C, RIO RANCHO, NM 87124-6300
(505) 636-6100
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
00000
NM
175T00000X
Peer Specialist
Primary
1635
NM
Other
Enumeration date
05/21/2024
Last updated
05/21/2024
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