Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2006-12-26
- Last updated
- 2025-09-29
Licenses
- License OR
- 0001239
Location
- Practice location
- 51600 HUNTINGTON RD, STE A
- City
- LA PINE OR
- Postal code
- 977398887
- Phone
- 541-536-1111
Organization contact
- Name
- BRANDON SANDOVAL
- Title
- Owner
- Phone
- 5415361111
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.