Provider Demographics
NPI:1275826851
Name:SANDOVAL, SAMANTHA DAWN
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:DAWN
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 1:8552 STONE MILL WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3662
Mailing Address - Country:US
Mailing Address - Phone:702-294-1198
Mailing Address - Fax:
Practice Address - Street 1:3047 E WARM SPRINGS RD BLDG 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3760
Practice Address - Country:US
Practice Address - Phone:702-677-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner