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General NPI Number Information
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NPI Number | 1649481383
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Entity Type | Individual
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Provider Name | MARTHA M SANDOVAL NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 245 S FETTERLY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90022-1605
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Country | US
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Telephone | 323-780-2216
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Fax |
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Provider Business Mailing Address
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Address Line | 425 S GREENWOOD AVE
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City | PASADENA
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State | CA
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Zip | 91107-5020
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Country | US
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Telephone | 626-577-5592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 319792
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License Number State | CA
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