Healthcare Provider Details

I. General information

NPI: 1124947270
Provider Name (Legal Business Name): ALEXANDRA SANDOVAL CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEX SANDOVAL CPSS

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WEDGEWOOD DR
LINCOLN NE
68510-2431
US

IV. Provider business mailing address

120 WEDGEWOOD DR
LINCOLN NE
68510-2431
US

V. Phone/Fax

Practice location:
  • Phone: 402-441-3768
  • Fax:
Mailing address:
  • Phone: 402-441-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCPSS-542
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: