Individual
SUSANA C SANDOVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
336 CHARDONNAY AVE, PROSSER, WA 99350-9515
(509) 786-1576
Mailing address
28094 STATE ROUTE 22, MABTON, WA 98935-9575
(509) 840-0773
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
MC11274
WA
Other
Enumeration date
05/21/2021
Last updated
05/21/2021
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