NPI 1306025036

Sandoval Center for Medicine, Chartered

Organisation Phlebology Physician Boise, ID

Practice location

Address: 1199 Shoreline Ln STE. 310, Boise, ID 83702-6813
Phone: (208) 333-1472
Fax: (208) 333-7757
Mailing address: PO Box 7130, Boise, ID 83707-1130

Authorised official

Name: Jesse Sandoval
Title: President
Phone: (208) 333-1472

Registered specialties

Phlebology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 202K00000X Licence O-124 (ID)

Other Phlebology providers in Idaho →

Registry record

NPI: 1306025036
Entity type: Organization
NPI issued: 30 Oct 2007
Record last updated: 11 Mar 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.