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General NPI Number Information
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NPI Number | 1629341904
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Entity Type | Individual
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Provider Name | MARIELA SANDOVAL M.S.
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Gender | Female
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 05/25/2017
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Provider Practice Location Address
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Address Line | GLASGOW AVE. COLLEGE PARK #1899
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City | SAN JUAN
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State | PR
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Zip | 00921-4834
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Country | US
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Telephone | 787-238-8580
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Fax |
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Provider Business Mailing Address
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Address Line | COLLEGE PARK GLASGOW AVE. 1899
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City | SAN JUAN
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State | PR
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Zip | 00921
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Country | US
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Telephone | 787-238-8580
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1124
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5590
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License Number State | PR
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