=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659239077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA SANDOVAL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2026
-----------------------------------------------------
Last Update Date | 01/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4695 MACARTHUR CT STE NEWPORT
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-1882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-418-2978
-----------------------------------------------------
Fax | 866-500-2186
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 806 E BORCHARD AVE
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92707-1920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-418-2978
-----------------------------------------------------
Fax | 866-500-2186
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------