Provider Demographics
NPI:1477848984
Name:SANDOVAL, JYNETTE LYNN (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:JYNETTE
Middle Name:LYNN
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 CALICO RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-6748
Mailing Address - Country:US
Mailing Address - Phone:956-225-4385
Mailing Address - Fax:
Practice Address - Street 1:478 CALICO RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-6748
Practice Address - Country:US
Practice Address - Phone:956-225-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider