Provider Demographics
NPI:1083475818
Name:SANDOVAL, JACKELINE IDOLINA
Entity Type:Individual
Prefix:MS
First Name:JACKELINE
Middle Name:IDOLINA
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 1:120 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2328
Mailing Address - Country:US
Mailing Address - Phone:442-265-1670
Mailing Address - Fax:442-265-1701
Practice Address - Street 1:120 N 8TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2328
Practice Address - Country:US
Practice Address - Phone:442-265-1670
Practice Address - Fax:442-265-1701
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor