Active NPI
Charise R. Sandoval
- Contractor
- Sahuarita, AZ
National Provider Identifier
1376739482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 218323
- Practice address
- 14803 S Avenida Cucana
Sahuarita, AZ 85629-8622 - Phone
- (520) 398-4528
- NPI assigned
- Sep 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 218323 | AZ | Primary |
Addresses
Primary practice location
14803 S Avenida Cucana
Sahuarita, AZ 85629-8622
Mailing address
14803 S Avenida Cucana
Sahuarita, AZ 85629-8622
Phone (520) 398-4528
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 218323 | Other | AZ | AHCCCS PROVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 218323 | AZ | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190332800000",
"number": "1376739482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14803 S AVENIDA CUCANA",
"city": "SAHUARITA",
"state": "AZ",
"postal_code": "856298622",
"telephone_number": "520-398-4528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14803 S AVENIDA CUCANA",
"city": "SAHUARITA",
"state": "AZ",
"postal_code": "856298622",
"telephone_number": "520-398-4528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDOVAL",
"first_name": "CHARISE",
"middle_name": "R.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-21",
"last_updated": "2007-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "AZ",
"license": "218323",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS PROVIDER",
"identifier": "218323",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sahuarita, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.