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General NPI Number Information
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NPI Number | 1023979481
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Entity Type | Individual
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Provider Name | RUDOLPH SANDOVAL
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Gender | Male
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 5861 CHERRY AVE
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City | LONG BEACH
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State | CA
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Zip | 90805-4405
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Country | US
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Telephone | 562-676-4259
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Fax |
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Provider Business Mailing Address
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Address Line | 12070 TELEGRAPH RD
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-3771
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Country | US
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Telephone | 562-777-7500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-VUTMZB
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License Number State | CA
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