Provider Demographics
NPI:1255048310
Name:SANDOVAL, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SANDOVAL
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 1:486 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:CA
Mailing Address - Zip Code:93250-9717
Mailing Address - Country:US
Mailing Address - Phone:661-778-7324
Mailing Address - Fax:
Practice Address - Street 1:486 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:CA
Practice Address - Zip Code:93250-9717
Practice Address - Country:US
Practice Address - Phone:661-778-7324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program