Provider Demographics
NPI:1275295875
Name:SANDOVAL, JUAN FRANCISCO
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:FRANCISCO
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6156
Mailing Address - Country:US
Mailing Address - Phone:773-418-2678
Mailing Address - Fax:
Practice Address - Street 1:190 W JOHNSON ST
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6156
Practice Address - Country:US
Practice Address - Phone:773-418-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017470101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor