Healthcare Provider Details

I. General information

NPI: 1669928552
Provider Name (Legal Business Name): MERCEDES SANDOVAL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MERCEDES M SANDOVAL LMSW

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LASER RD NE
RIO RANCHO NM
87124-4517
US

IV. Provider business mailing address

9945 BELLEVUE ST NW
ALBUQUERQUE NM
87114-4112
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0667
  • Fax:
Mailing address:
  • Phone: 505-338-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number268426
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: