Healthcare Provider Details

I. General information

NPI: 1336550466
Provider Name (Legal Business Name): KATHRYN SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SOAVE DR SE
RIO RANCHO NM
87124-8849
US

IV. Provider business mailing address

1401 SOAVE DR SE
RIO RANCHO NM
87124-8849
US

V. Phone/Fax

Practice location:
  • Phone: 505-490-1998
  • Fax:
Mailing address:
  • Phone: 505-490-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: