Healthcare Provider Details

I. General information

NPI: 1518504463
Provider Name (Legal Business Name): JOELENE IBANEZ-SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4152 W SWIFT AVE STE 104
FRESNO CA
93722-6388
US

IV. Provider business mailing address

7010 N PALM AVE STE 101
FRESNO CA
93650-1087
US

V. Phone/Fax

Practice location:
  • Phone: 559-724-3702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-91006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: