Healthcare Provider Details

I. General information

NPI: 1275144560
Provider Name (Legal Business Name): ERIN SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/26/2025
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 MAIN ST NW
LOS LUNAS NM
87031-8712
US

IV. Provider business mailing address

PO BOX 1300
LOS LUNAS NM
87031-1300
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-6440
  • Fax:
Mailing address:
  • Phone: 505-866-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX-11516
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0667
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: