Provider Demographics
NPI:1104338128
Name:YVONNE SANDOVAL AND ASSOCIATES
Entity type:Organization
Organization Name:YVONNE SANDOVAL AND ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-297-4444
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:VILLANUEVA
Mailing Address - State:NM
Mailing Address - Zip Code:87583-0114
Mailing Address - Country:US
Mailing Address - Phone:575-421-0242
Mailing Address - Fax:
Practice Address - Street 1:2921 CARLISLE BLVD NE STE 111
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2850
Practice Address - Country:US
Practice Address - Phone:575-421-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YVONNE SANDOVAL AND ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-10093251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health