Healthcare Provider Details

I. General information

NPI: 1922758358
Provider Name (Legal Business Name): RAQUEL SOFIA SANDOVAL MD,MPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N MAIN ST
TUBA CITY AZ
86045
US

IV. Provider business mailing address

167 N MAIN ST
TUBA CITY AZ
86045
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone: 410-955-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0107161
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0107161
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: