Provider Demographics
NPI:1154999811
Name:SANDOVAL, DAISY LARA CASTANEDA
Entity type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:LARA CASTANEDA
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:PO BOX 1096
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-1096
Mailing Address - Country:US
Mailing Address - Phone:707-703-9447
Mailing Address - Fax:
Practice Address - Street 1:2227 MERCURY WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-1486
Practice Address - Country:US
Practice Address - Phone:707-703-9447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical