Jennifer Sandoval, LADAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Isleta, NM
NPI 1649265711 · NPPES record last updated May 16, 2012
Key facts
- NPI
- 1649265711
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 3850 (NM)
- Practice address
- 01 Sagebrush Street
Isleta, NM 87022 - Phone
- (505) 869-5474
- Fax
- (505) 869-4584
- NPI assigned
- Sep 15, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3850 | NM | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3850 | NM | Yes |
Addresses
Primary practice location
01 Sagebrush Street
Isleta, NM 87022
Mailing address
PO Box 640
Isleta, NM 87022
Phone (505) 869-5474
Other providers in Isleta, NM
- Pueblo of Isleta Assisted Living Facility
- Pueblo of Isleta Behavioral Health
- Gabriel I Rael
- John James Richter III
- Karen Marie Roop
- Juanita Sena
- Brandy L. Shinnick
- Veronica Sprunk
- Emily J. Stafford
- Santana M Titla
All providers in Isleta, NM · Addiction (Substance Use Disorder) Counselor in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.