Provider Demographics
NPI:1073261830
Name:SANDOVAL, LIZETH JUDITH
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:JUDITH
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 INDIAN SCHOOL RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4504
Mailing Address - Country:US
Mailing Address - Phone:505-266-0441
Mailing Address - Fax:505-266-0504
Practice Address - Street 1:7301 INDIAN SCHOOL RD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4504
Practice Address - Country:US
Practice Address - Phone:505-266-0441
Practice Address - Fax:505-266-0504
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-11186104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker