Provider Demographics
NPI:1144514118
Name:SANDOVAL, JENNIFER L (LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 E FORT LOWELL RD
Mailing Address - Street 2:STE B
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1514
Mailing Address - Country:US
Mailing Address - Phone:520-205-0215
Mailing Address - Fax:
Practice Address - Street 1:2550 E FORT LOWELL RD
Practice Address - Street 2:STE B
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1514
Practice Address - Country:US
Practice Address - Phone:520-205-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0482171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist