MEDICARE: SANDRA SANDOVAL

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	106H00000X	Marriage & Family Therapist	AMFT133432	CA

General Provider Information

NPI Number	:	1467911958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA SANDOVAL

Provider Business Mailing Address
First Line	:	10067 WALNUT GROVE AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5423
Country	:	US
Telephone Number	:	951-476-5992
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 HAVEN AVE STE 200
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-5839
Country	:	US
Telephone Number	:	951-476-5992
Fax Number	:

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

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	06/18/2024

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Directions to “ SANDRA SANDOVAL ” Practice Location

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