Organization
SANDOVAL CENTER FOR MEDICINE, CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE SANDOVAL D.O. (PRESIDENT)
(208) 333-1472
Entity
Organization
Contact information
Practice address
1199 SHORELINE LN, STE. 310, BOISE, ID 83702-6813
(208) 333-1472
(208) 333-7757
Mailing address
PO BOX 7130, BOISE, ID 83707-1130
(208) 333-1472
(208) 333-7757
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
O-124
ID
Other
Enumeration date
10/30/2007
Last updated
03/11/2008
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