Individual
JAMIE MIRANDA SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1214 NATIONAL AVE, LAS VEGAS, NM 87701-4033
(505) 426-8095
Mailing address
718 CORONADO DR, LAS VEGAS, NM 87701-4906
(505) 617-1125
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2022-0707
NM
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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