Provider Demographics
NPI:1013305267
Name:SANDOVAL, JANICE LUANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LUANNE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:LUANNE
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5974 MOON GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4529
Mailing Address - Country:US
Mailing Address - Phone:702-561-3796
Mailing Address - Fax:
Practice Address - Street 1:3001 SAINT ROSE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3839
Practice Address - Country:US
Practice Address - Phone:702-616-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant