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General NPI Number Information
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NPI Number | 1407238710
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Entity Type | Individual
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Provider Name | SANDRA MINTZ M.S. CCC-A
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Gender | Female
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 5100 ADOLFO RD
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City | CAMARILLO
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State | CA
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Zip | 93012-6792
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Country | US
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Telephone | 805-437-1380
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Fax | 805-389-4297
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Provider Business Mailing Address
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Address Line | 5100 ADOLFO RD
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City | CAMARILLO
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State | CA
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Zip | 93012-6792
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Country | US
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Telephone | 805-437-1380
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Fax | 805-389-4297
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU2601
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 231HA2400X
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Taxonomy Name | Assistive Technology Practitioner Audiologist
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License Number | AU2601
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License Number State | CA
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