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General NPI Number Information
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NPI Number | 1922516962
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Entity Type | Organization
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Legal Business Name | MIND CARE SERVICES
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 333 W BROADWAY STE 310
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City | LONG BEACH
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State | CA
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Zip | 90802-4438
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Country | US
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Telephone | 949-722-7118
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 RUHLAND AVE
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City | REDONDO BEACH
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State | CA
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Zip | 90278-2420
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Country | US
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Telephone | 317-417-0656
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. SABRINA SANDOVAL
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Credential | MD
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Telephone | 317-417-0656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 324841
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License Number State | CA
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