Individual
MRS. LISA ELLEN SANDOVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
500 W HOBBS ST, ROSWELL, NM 88203-1834
(505) 637-3200
Mailing address
2803 PURDUE DR, ROSWELL, NM 88203-2375
(505) 625-1968
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
186
NM
Other
Enumeration date
06/26/2006
Last updated
07/08/2007
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