MEDICARE: SUTIWEYU 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	172V00000X	Community Health Worker	MPSS-FUMTAR	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952139917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUTIWEYU SANDOVAL

Provider Business Mailing Address
First Line	:	8623 S VERMONT AVE APT 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-4855
Country	:	US
Telephone Number	:	323-781-5238
Fax Number	:

Provider Business Practice Location Address
First Line	:	8623 S VERMONT AVE APT 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-4855
Country	:	US
Telephone Number	:	323-781-5238
Fax Number	:

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

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

Similar Medicare Providers

1780797340 — DR. VISAYAS BORGONIA MONTEJO DMD
Practice Location Address:

4855 SANTA MONICA BLVD. , VISAYAS B. MONTEJO, DMD SUITE #111
LOS ANGELES, CA
90029

Practice Phone: 323-664-9363
Practice Fax: 323-668-2851

1760679104 — MR. PREM NATH M.SC
Practice Location Address:

5601 W OLYMPIC BLVD , 101
LOS ANGELES, CA
90036-4855

Practice Phone: 323-379-7189
Practice Fax: 323-379-7189

1891967246 — INGA TAMAZOVA
Practice Location Address:

4855 SANTA MONICA BLVD , 114
LOS ANGELES, CA
90029-2654

Practice Phone: 323-906-9090
Practice Fax: 323-906-9696

1437403540 — MR. PAUL R HUNTER M.A. ED.S. BCBA
Practice Location Address:

4855 LINCOLN AVE
LOS ANGELES, CA
90042-1607

Practice Phone: 323-369-4145
Practice Fax:

1679941405 — HOLLYWOOD PHYSICAL THERAPY
Practice Location Address:

4855 SANTA MONICA BLVD STE 102
LOS ANGELES, CA
90029-2654

Practice Phone: 323-741-8500
Practice Fax:

1629435805 — KATHLEEN KANG
Practice Location Address:

5601 W OLYMPIC BLVD , 101
LOS ANGELES, CA
90036-4855

Practice Phone: 310-748-1146
Practice Fax:

Directions to “ SUTIWEYU SANDOVAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.