Healthcare Provider Details

I. General information

NPI: 1780500579
Provider Name (Legal Business Name): ALFREDO SANDOVAL PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14708 PIPELINE AVE STE B
CHINO HILLS CA
91709-1296
US

IV. Provider business mailing address

1758 KENNETH WAY
PASADENA CA
91103-1252
US

V. Phone/Fax

Practice location:
  • Phone: 909-393-8585
  • Fax:
Mailing address:
  • Phone: 626-993-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: