Healthcare Provider Details

I. General information

NPI: 1205790334
Provider Name (Legal Business Name): BRITTNEY SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTNEY PHILLIPS

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W D ST
ONTARIO CA
91762-3026
US

IV. Provider business mailing address

15675 PARRY PEAK DR
FONTANA CA
92336-4640
US

V. Phone/Fax

Practice location:
  • Phone: 909-459-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: