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NPI Code Detail

MEDICARE: RYAN CHRISTOPHER SANDOVAL RADT-I

MEDICARE: RYAN CHRISTOPHER SANDOVAL RADT-I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorR1541180124CA

General Provider Information

NPI Number : 1124979208
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN CHRISTOPHER SANDOVAL RADT-I
Provider Business Mailing Address
First Line : 550 W WASHINGTON AVE
Second Line :
City : ESCONDIDO
State : CA
Zip : 92025-1643
Country : US
Telephone Number : 760-489-6380
Fax Number :
Provider Business Practice Location Address
First Line : 550 W WASHINGTON AVE
Second Line :
City : ESCONDIDO
State : CA
Zip : 92025-1643
Country : US
Telephone Number : 760-489-6380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2026
Last Update Date : 02/05/2026

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