Healthcare Provider Details

I. General information

NPI: 1689198723
Provider Name (Legal Business Name): NICOLE SANDOVAL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W IMPERIAL HWY STE K
BREA CA
92821-4841
US

IV. Provider business mailing address

407 W IMPERIAL HWY STE K
BREA CA
92821-4841
US

V. Phone/Fax

Practice location:
  • Phone: 562-324-4229
  • Fax: 562-324-4229
Mailing address:
  • Phone: 562-324-4229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: