Individual
JESUS EDUARDO SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
617 N SCOTTSDALE RD STE D, SCOTTSDALE, AZ 85257-4207
(480) 990-3720
Mailing address
2529 W CACTUS RD APT 3014, PHOENIX, AZ 85029-2588
(623) 853-6282
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
LP054802
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D08258128
DRIVER LICENSE NUMBER
AZ
Enumeration date
02/11/2022
Last updated
02/11/2022
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