MEDICARE: ALVIC 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
1	163WH0200X	Home Health Registered Nurse	886034	NV

General Provider Information

NPI Number	:	1780530980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVIC SANDOVAL

Provider Business Mailing Address
First Line	:	11179 ANTONINE WALL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4338
Country	:	US
Telephone Number	:	702-405-9596
Fax Number	:

Provider Business Practice Location Address
First Line	:	11179 ANTONINE WALL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4338
Country	:	US
Telephone Number	:	702-405-9596
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ ALVIC SANDOVAL ” Practice Location

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