Provider Demographics
NPI:1710182639
Name:SANDOVAL, AMY JO (LVN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 KLAMATH RD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-4933
Mailing Address - Country:US
Mailing Address - Phone:916-803-4963
Mailing Address - Fax:
Practice Address - Street 1:1773 KLAMATH RD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4933
Practice Address - Country:US
Practice Address - Phone:916-803-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210431164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse