Basic Information
| Provider Information | |||||||||
| NPI: | 1548492051 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDOVAL | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 FRIEDMAN AVE | ||||||||
| Address2: | 3695 HOT SPRINGS BLVD. | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 877014231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054545100 | ||||||||
| FaxNumber: | 5054540397 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 FRIEDMAN AVE | ||||||||
| Address2: | 3695 HOT SPRINGS BLVD. | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 877014231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054545100 | ||||||||
| FaxNumber: | 5054540397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2009 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I-1324 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.