Healthcare Provider Details

I. General information

NPI: 1154230514
Provider Name (Legal Business Name): ALICIA LILIANA SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1716 COTTONWOOD ST
WOODLAND CA
95695-5137
US

IV. Provider business mailing address

950 ARLINGTON CIR
WOODLAND CA
95695-2877
US

V. Phone/Fax

Practice location:
  • Phone: 530-666-3641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number25852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: