Healthcare Provider Details

I. General information

NPI: 1831055656
Provider Name (Legal Business Name): ROSARIO SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2025
Last Update Date: 12/25/2025
Certification Date: 12/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 W COMMONWEALTH AVE
ALHAMBRA CA
91803-1506
US

IV. Provider business mailing address

1822 W COMMONWEALTH AVE
ALHAMBRA CA
91803-1506
US

V. Phone/Fax

Practice location:
  • Phone: 818-723-4397
  • Fax:
Mailing address:
  • Phone: 818-723-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number136014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: