Provider Demographics
NPI:1609011550
Name:SANDOVOL, MARIA CONCEPCION
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CONCEPCION
Last Name:SANDOVOL
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 1:6018 SW 18TH ST
Mailing Address - Street 2:SUITE C10
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7199
Mailing Address - Country:US
Mailing Address - Phone:561-901-6367
Mailing Address - Fax:561-416-1768
Practice Address - Street 1:6018 SW 18TH ST
Practice Address - Street 2:SUITE C10
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7199
Practice Address - Country:US
Practice Address - Phone:561-901-6367
Practice Address - Fax:561-416-1768
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54170225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist