Healthcare Provider Details

I. General information

NPI: 1679402754
Provider Name (Legal Business Name): ADELAIDA SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 S WATERMAN AVE
EL CENTRO CA
92243-4142
US

IV. Provider business mailing address

2130 CARTER CT
CALEXICO CA
92231-4316
US

V. Phone/Fax

Practice location:
  • Phone: 760-312-6630
  • Fax:
Mailing address:
  • Phone: 760-693-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: