Provider Demographics
NPI:1366995458
Name:SANDOVAL, IVETH (MD)
Entity type:Individual
Prefix:
First Name:IVETH
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:21890 W. COLORADO AVENUE
Mailing Address - City:SAN JOAQUIN
Mailing Address - State:CA
Mailing Address - Zip Code:93660-0737
Mailing Address - Country:US
Mailing Address - Phone:559-456-5560
Mailing Address - Fax:
Practice Address - Street 1:21890 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:SAN JOAQUIN
Practice Address - State:CA
Practice Address - Zip Code:93660-9773
Practice Address - Country:US
Practice Address - Phone:559-456-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program