Healthcare Provider Details

I. General information

NPI: 1154241610
Provider Name (Legal Business Name): LUIS SANDOVAL RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 THARP RD
YUBA CITY CA
95993-2645
US

IV. Provider business mailing address

3242 VIOLET CT
LIVE OAK CA
95953-2392
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-3242
  • Fax:
Mailing address:
  • Phone: 530-216-8496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH36395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: