Healthcare Provider Details

I. General information

NPI: 1629905500
Provider Name (Legal Business Name): MICHAEL CORY SANDOVAL MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83800 AIRPORT BLVD
THERMAL CA
92274-9367
US

IV. Provider business mailing address

690 W AVENUE L
CALIMESA CA
92320-1020
US

V. Phone/Fax

Practice location:
  • Phone: 760-399-5183
  • Fax:
Mailing address:
  • Phone: 909-277-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: