Provider Demographics
NPI:1457997421
Name:SANDOVAL, ERICA ADELLE
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:ADELLE
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 1:948 WATERFALL DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-3708
Mailing Address - Country:US
Mailing Address - Phone:505-910-2831
Mailing Address - Fax:
Practice Address - Street 1:948 WATERFALL DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-3708
Practice Address - Country:US
Practice Address - Phone:505-910-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician