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NPI Code Detail

MEDICARE: BARBARA SANDOVAL MSW

MEDICARE: BARBARA SANDOVAL MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerM-0262NM

General Provider Information

NPI Number : 1225561020
Entity Type Code : Individual
Provider Name (Legal Business Name) : BARBARA SANDOVAL MSW
Provider Business Mailing Address
First Line : 2528 RIDGE RUNNER RD
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4971
Country : US
Telephone Number : 505-490-1439
Fax Number :
Provider Business Practice Location Address
First Line : 2528 RIDGE RUNNER RD
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4971
Country : US
Telephone Number : 505-490-1439
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2017
Last Update Date : 04/07/2017

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