Healthcare Provider Details

I. General information

NPI: 1891272878
Provider Name (Legal Business Name): DIEGO SANDOVAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 6TH ST
WASCO CA
93280-1948
US

IV. Provider business mailing address

29341 KIMBERLINA RD STE 102
WASCO CA
93280-7617
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-4029
  • Fax: 661-758-0891
Mailing address:
  • Phone: 661-758-4029
  • Fax: 661-758-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: