Provider Demographics
NPI:1043772502
Name:SANDOVAL, ANGIE ANN
Entity type:Individual
Prefix:MISS
First Name:ANGIE
Middle Name:ANN
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33050 ANTELOPE RD STE 201-202
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2489
Mailing Address - Country:US
Mailing Address - Phone:844-417-2417
Mailing Address - Fax:
Practice Address - Street 1:33050 ANTELOPE RD STE 201-202
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2489
Practice Address - Country:US
Practice Address - Phone:844-417-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist