Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Gary Lee Sandoval

Individual provider PACE Provider Organization · NPI 1922786763

Gary Lee Sandoval is a PACE Provider Organization in Albuquerque, New Mexico. Practices as a sole proprietor. Licensed in New Mexico.

Licensed in
NM
In the registry since
2023
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Practice location Address checks out

2111 Raven Ln SW
Albuquerque, NM 87105-4530
Phone: (505) 573-2721
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

PACE Provider Organization (primary) Taxonomy 251T00000X · Licence 5280 (NM)

Record details

NPI number1922786763
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 11, 2023
Last updated in NPPESAugust 21, 2023
Certification dateAugust 21, 2023
Mailing address2111 Raven Ln Sw, Albuquerque, NM 87105-4530

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