Provider Demographics
NPI:1396810487
Name:SANDOVAL, VICKY MONICA (ASSOCIATE SOCIAL WOR)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:MONICA
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:ASSOCIATE SOCIAL WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 E HEMAN
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401
Mailing Address - Country:US
Mailing Address - Phone:505-461-4810
Mailing Address - Fax:
Practice Address - Street 1:1005 S MONROE
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401
Practice Address - Country:US
Practice Address - Phone:505-461-6122
Practice Address - Fax:505-461-1169
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker