MEDICARE: MR. ROBERT MARK SANDOVAL CATC III

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	17512	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1962273508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT MARK SANDOVAL CATC III

Provider Business Mailing Address
First Line	:	85 RAMONA EXPY
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92571-7014
Country	:	US
Telephone Number	:	626-348-1441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 N INDIAN CANYON DR STE A
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4880
Country	:	US
Telephone Number	:	760-322-9065
Fax Number	:

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

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	02/09/2026

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