Individual
CHARISE R. SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14803 S AVENIDA CUCANA, SAHUARITA, AZ 85629-8622
(520) 398-4528
Mailing address
14803 S AVENIDA CUCANA, SAHUARITA, AZ 85629-8622
(520) 398-4528
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
218323
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218323
AHCCCS PROVIDER
AZ
Enumeration date
09/21/2007
Last updated
09/21/2007
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