Provider Demographics
NPI:1568108785
Name:AHUMADA, SANDY
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:AHUMADA
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 1:220 S INDIAN HILL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4929
Mailing Address - Country:US
Mailing Address - Phone:626-634-2419
Mailing Address - Fax:
Practice Address - Street 1:1242 S BONNIE BEACH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-3302
Practice Address - Country:US
Practice Address - Phone:323-496-3589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program