Healthcare Provider Details

I. General information

NPI: 1912668047
Provider Name (Legal Business Name): LISET SANDOVAL CSFA, LSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2696
US

IV. Provider business mailing address

8015 GREENBELT STATION PKWY
GREENBELT MD
20770-4076
US

V. Phone/Fax

Practice location:
  • Phone: 202-427-3565
  • Fax:
Mailing address:
  • Phone: 202-427-3565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: