Healthcare Provider Details

I. General information

NPI: 1598994303
Provider Name (Legal Business Name): MONICA M. SANDOVAL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/21/2022
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO ALBUQUERQUE NM MSC10 5550
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4868
  • Fax: 505-272-9134
Mailing address:
  • Phone: 505-272-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberD75129
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD2017-0641
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: