Healthcare Provider Details

I. General information

NPI: 1104756964
Provider Name (Legal Business Name): ANNA SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 HENSON RD TRLR 2
ASHEBORO NC
27203-3287
US

IV. Provider business mailing address

1819 HENSON RD TRLR 2
ASHEBORO NC
27203-3287
US

V. Phone/Fax

Practice location:
  • Phone: 650-458-1369
  • Fax:
Mailing address:
  • Phone: 650-458-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-523124
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: