Healthcare Provider Details

I. General information

NPI: 1093643116
Provider Name (Legal Business Name): CAROLINA VICTORIA SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N TELSHOR BLVD STE A
LAS CRUCES NM
88011-8234
US

IV. Provider business mailing address

532 N TELSHOR BLVD STE A
LAS CRUCES NM
88011-8234
US

V. Phone/Fax

Practice location:
  • Phone: 575-224-6070
  • Fax:
Mailing address:
  • Phone: 575-224-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0294
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: