Provider Demographics
NPI:1194071902
Name:SANDOVAL, GABRIEL JOESPH (BA)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JOESPH
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2082 W 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1413
Mailing Address - Country:US
Mailing Address - Phone:720-220-5354
Mailing Address - Fax:
Practice Address - Street 1:456 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5126
Practice Address - Country:US
Practice Address - Phone:303-504-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator