Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 279940 | NM |
NPI | 1023441300 |
---|---|
Provider Name | Suzette L Sandoval |
First Address | Albuquerque, NM 87107-3336 |
Second Address | Albuquerque, NM 87176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2013 |
Last Update Date | 09/08/2013 |