Provider Demographics
NPI:1285865964
Name:SANDOVAL, PANSIE WILSON (BUS, MED)
Entity Type:Individual
Prefix:
First Name:PANSIE
Middle Name:WILSON
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:BUS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 IH 37 APT 2802
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-3345
Mailing Address - Country:US
Mailing Address - Phone:361-510-1696
Mailing Address - Fax:
Practice Address - Street 1:11325 IH 37 APT 2802
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-3345
Practice Address - Country:US
Practice Address - Phone:361-510-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst