Sandoval Center for Medicine, Chartered

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

License

O-124 Issued in ID

Legal business name

SANDOVAL CENTER FOR MEDICINE, CHARTERED

Practice address

1199 Shoreline LN
Ste. 310
Boise, ID 83702-6813

Phone

(208) 333-1472

Fax

(208) 333-7757

NPI assigned

Oct 30, 2007

Last updated

Mar 11, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jesse Sandoval, D.O.NPI 1972552271

Title

President

Phone

(208) 333-1472

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jesse Sandoval, D.O.

  • Phlebology Physician
  • Soldotna, AK
  • NPI 1972552271
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1306025036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7130",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837071130",
            "telephone_number": "208-333-1472",
            "fax_number": "208-333-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1199 SHORELINE LN",
            "address_2": "STE. 310",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026813",
            "telephone_number": "208-333-1472",
            "fax_number": "208-333-7757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDOVAL CENTER FOR MEDICINE, CHARTERED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "SANDOVAL",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-333-1472",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "ID",
            "license": "O-124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Sanderson, MD
• Ariel Sandifer, FNP
• Megan Sandmann, MD
• Ranan Grace Sandmeyer, NP-C
• Tamara Sandmeyer, NP-C
• Audra Sandoval, PHARMD, BCPS, MSCP
• Elia Sandoval
• Lucia Sandoval, LPC
• Ronald T. Sandow, NP-C
• Alan Neil Sands, O.D.

• Phlebology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Phlebology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.