Provider Demographics
NPI:1912106204
Name:SANDOVAL, HERMELINDA
Entity Type:Individual
Prefix:MS
First Name:HERMELINDA
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 1:1210 S BASCOM AVE
Mailing Address - Street 2:STE 224
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3543
Mailing Address - Country:US
Mailing Address - Phone:408-260-2625
Mailing Address - Fax:
Practice Address - Street 1:1210 S BASCOM AVE
Practice Address - Street 2:STE 224
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3543
Practice Address - Country:US
Practice Address - Phone:408-260-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42326OtherUNICARE