Provider Demographics
NPI:1922477090
Name:SANDOVAL, ISABEL (RN)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-6387
Mailing Address - Country:US
Mailing Address - Phone:408-680-1800
Mailing Address - Fax:
Practice Address - Street 1:2029 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2767
Practice Address - Country:US
Practice Address - Phone:408-680-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484004163W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies