Provider Demographics
NPI:1093934689
Name:DUVAL, SANDRA JEAN
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JEAN
Last Name:DUVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:DUVAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8920 E BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-7837
Mailing Address - Country:US
Mailing Address - Phone:480-380-2830
Mailing Address - Fax:480-380-2830
Practice Address - Street 1:8920 E BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-7837
Practice Address - Country:US
Practice Address - Phone:480-380-2830
Practice Address - Fax:480-380-2830
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies