Provider Demographics
NPI:1689247439
Name:SANDOVAL AGUIRRE, SALLY
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:SANDOVAL AGUIRRE
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 1:1726 W 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-3427
Mailing Address - Country:US
Mailing Address - Phone:509-374-6707
Mailing Address - Fax:
Practice Address - Street 1:1726 W 17TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-3427
Practice Address - Country:US
Practice Address - Phone:509-374-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC13339171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter