Individual
JAMES SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NONE
Contact information
Practice address
.5 MILES EAST OF HWY 371, THOREAU, NM 87323
(505) 905-0061
(505) 905-0064
Mailing address
PO BOX 1289, THOREAU, NM 87323-1289
(505) 905-0061
(505) 905-0064
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NM
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8600922335
NAVAJO NATION
NM
Enumeration date
05/11/2011
Last updated
05/11/2011
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