Healthcare Provider Details

I. General information

NPI: 1114016656
Provider Name (Legal Business Name): ISABEL SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SE 2ND ST
PENDLETON OR
97801-2224
US

IV. Provider business mailing address

PO BOX 1290
ONTARIO OR
97914-0136
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-6207
  • Fax: 541-276-4628
Mailing address:
  • Phone: 541-889-9167
  • Fax: 541-889-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: