Individual
CIRILO SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1200 N PASEO DE ONATE, ESPANOLA, NM 87532-2687
(505) 443-2800
Mailing address
1200 N PASEO DE ONATE, ESPANOLA, NM 87532-2687
(505) 443-2800
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-1139
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235231440
—
NM
05
—
A0175
—
NM
Enumeration date
09/01/2006
Last updated
07/21/2022
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