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General NPI Number Information
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NPI Number | 1467576629
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Entity Type | Individual
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Provider Name | JENNIFER SAMANTHA SANDOVAL PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 1011 CAMINO DEL MAR SUITE 270
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City | DEL MAR
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State | CA
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Zip | 92014-2640
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Country | US
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Telephone | 626-590-9723
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Fax |
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Provider Business Mailing Address
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Address Line | 8971 CAMINITO FRESCO
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City | LA JOLLA
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State | CA
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Zip | 92037-1602
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Country | US
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Telephone | 626-590-9723
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY18127
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License Number State | CA
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