=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952237562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOFIA BEATRIZ SANDOVAL BS, DNP, CNL, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2026
-----------------------------------------------------
Last Update Date | 06/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1311 PRAIRIE DR
-----------------------------------------------------
City | MT PLEASANT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53406-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-455-0300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1311 PRAIRIE DR
-----------------------------------------------------
City | MT PLEASANT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53406-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-455-0300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1857033
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------