Healthcare Provider Details

I. General information

NPI: 1720408958
Provider Name (Legal Business Name): ASHLEY SANDOVAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 WOODRUFF AVE STE 209
LONG BEACH CA
90808-2145
US

IV. Provider business mailing address

3816 WOODRUFF AVE STE 209
LONG BEACH CA
90808-2145
US

V. Phone/Fax

Practice location:
  • Phone: 562-496-4749
  • Fax:
Mailing address:
  • Phone: 562-496-4749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA139931
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA139931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: