Healthcare Provider Details

I. General information

NPI: 1962273508
Provider Name (Legal Business Name): ROBERT MARK SANDOVAL CATC III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N INDIAN CANYON DR STE A
PALM SPRINGS CA
92262-4880
US

IV. Provider business mailing address

85 RAMONA EXPY
PERRIS CA
92571-7014
US

V. Phone/Fax

Practice location:
  • Phone: 760-322-9065
  • Fax:
Mailing address:
  • Phone: 626-348-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17512
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: