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NPI Code Detail

MEDICARE: IRASEMA SANDOVAL LMFT

MEDICARE: IRASEMA SANDOVAL LMFT
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
1106H00000XMarriage & Family Therapist97084CA

General Provider Information

NPI Number : 1942647672
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRASEMA SANDOVAL LMFT
Provider Business Mailing Address
First Line : 4401 ATLANTIC AVE STE 200
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-2264
Country : US
Telephone Number : 626-600-1599
Fax Number :
Provider Business Practice Location Address
First Line : 4401 ATLANTIC AVE STE 200
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-2264
Country : US
Telephone Number : 626-600-1599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2013
Last Update Date : 05/31/2024

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Directions to “ IRASEMA SANDOVAL LMFT” Practice Location

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