Provider Demographics
NPI:1174416481
Name:SANDOVAL, ISABEL ATHENA
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:ATHENA
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 W MARCH LN STE 2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6422
Mailing Address - Country:US
Mailing Address - Phone:209-808-8858
Mailing Address - Fax:
Practice Address - Street 1:2105 W MARCH LN STE 2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6422
Practice Address - Country:US
Practice Address - Phone:209-808-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist