Provider Demographics
NPI:1043340995
Name:SANDOVAL, CHRISTIE CANEDO (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:CANEDO
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15681 W MESCAL ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4693
Mailing Address - Country:US
Mailing Address - Phone:623-337-4338
Mailing Address - Fax:
Practice Address - Street 1:13500 N EL MIRAGE RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-2469
Practice Address - Country:US
Practice Address - Phone:623-876-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ132569163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ171282Medicare ID - Type Unspecified