MEDICARE: RAQUEL JAHNE SANDOVAL-GARCIA CNA, DSW, HHA, PSW

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
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1649939463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL JAHNE SANDOVAL-GARCIA CNA, DSW, HHA, PSW

Provider Business Mailing Address
First Line	:	8413 SW MONICA CT
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-2109
Country	:	US
Telephone Number	:	503-593-8421
Fax Number	:

Provider Business Practice Location Address
First Line	:	8422 NE 8TH WAY
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1974
Country	:	US
Telephone Number	:	360-256-2980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	12/08/2021

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