Healthcare Provider Details

I. General information

NPI: 1821808056
Provider Name (Legal Business Name): DINA DONATO SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DINA DONATO

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N 6TH ST STE E
REDLANDS CA
92373-5261
US

IV. Provider business mailing address

1901 CARNEGIE AVE
SANTA ANA CA
92705-5504
US

V. Phone/Fax

Practice location:
  • Phone: 909-693-9256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: