Healthcare Provider Details

I. General information

NPI: 1922516962
Provider Name (Legal Business Name): MIND CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W BROADWAY STE 310
LONG BEACH CA
90802-4438
US

IV. Provider business mailing address

2110 RUHLAND AVE
REDONDO BEACH CA
90278-2420
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-7118
  • Fax:
Mailing address:
  • Phone: 317-417-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number324841
License Number StateCA

VIII. Authorized Official

Name: MRS. SABRINA SANDOVAL
Title or Position: CEO
Credential: MD
Phone: 317-417-0656