Healthcare Provider Details

I. General information

NPI: 1841659745
Provider Name (Legal Business Name): JACOB SANDOVAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 200
OXNARD CA
93036-0673
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-4233
  • Fax:
Mailing address:
  • Phone: 805-981-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number90611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: