MEDICARE: KASIRAPA PATSY SANDOVAL PSYD

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	103TC0700X	Clinical Psychologist	PSY23455	CA

General Provider Information

NPI Number	:	1639202807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASIRAPA PATSY SANDOVAL PSYD

Provider Business Mailing Address
First Line	:	2088 S ATLANTIC BLVD # 403
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-6304
Country	:	US
Telephone Number	:	626-548-8479
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 E FOOTHILL BLVD STE 208
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-2600
Country	:	US
Telephone Number	:	626-808-4149
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	10/29/2025

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