Provider Demographics
NPI:1396214607
Name:SANDOVAL, ANA M
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
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 1:14780 E KENTUCKY DR APT 416
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3720
Mailing Address - Country:US
Mailing Address - Phone:720-210-3979
Mailing Address - Fax:
Practice Address - Street 1:6303 WADSWORTH BYPASS,
Practice Address - Street 2:SUITE 100
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003
Practice Address - Country:US
Practice Address - Phone:303-935-7004
Practice Address - Fax:303-935-3035
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0334342164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse