MEDICARE: MR. RENE Q SANDOVAL LCSW

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
1	1041C0700X	Clinical Social Worker	24599	CA

General Provider Information

NPI Number	:	1295846442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RENE Q SANDOVAL LCSW

Provider Business Mailing Address
First Line	:	9630 PILLITERI WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-4615
Country	:	US
Telephone Number	:	916-753-5617
Fax Number	:	916-922-7342

Provider Business Practice Location Address
First Line	:	8788 ELK GROVE BLVD STE J
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1768
Country	:	US
Telephone Number	:	916-753-5617
Fax Number	:	916-687-3140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/10/2026

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