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NPI Code Detail

MEDICARE: JAMIE MIRANDA SANDOVAL

MEDICARE: JAMIE MIRANDA SANDOVAL
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
1101YM0800XMental Health CounselorCTB-2022-0707NM

General Provider Information

NPI Number : 1518675784
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE MIRANDA SANDOVAL
Provider Business Mailing Address
First Line : 718 CORONADO DR
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4906
Country : US
Telephone Number : 505-617-1125
Fax Number :
Provider Business Practice Location Address
First Line : 1214 NATIONAL AVE
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4033
Country : US
Telephone Number : 505-426-8095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2022
Last Update Date : 11/07/2022

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Directions to “ JAMIE MIRANDA SANDOVAL ” Practice Location

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