Healthcare Provider Details

I. General information

NPI: 1902298441
Provider Name (Legal Business Name): ANTHONY SANDOVAL-JUNIO BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W BEAMER ST
WOODLAND CA
95695-2510
US

IV. Provider business mailing address

215 W BEAMER ST
WOODLAND CA
95695-2510
US

V. Phone/Fax

Practice location:
  • Phone: 530-405-2815
  • Fax:
Mailing address:
  • Phone: 530-405-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRT1419070925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: