Provider Demographics
NPI:1386877637
Name:SANDOVAL, ENRIQUE SINNEL (BA)
Entity type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:SINNEL
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 POPPY AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2426
Mailing Address - Country:US
Mailing Address - Phone:213-271-7563
Mailing Address - Fax:
Practice Address - Street 1:1890 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2923
Practice Address - Country:US
Practice Address - Phone:909-629-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN860OtherLA COUNTY DMH