Provider Demographics
NPI:1588152011
Name:SANDOVAL, DAVID (MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W GLADSTONE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2957
Mailing Address - Country:US
Mailing Address - Phone:626-634-1565
Mailing Address - Fax:626-226-4906
Practice Address - Street 1:910 W GLADSTONE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2957
Practice Address - Country:US
Practice Address - Phone:626-634-1565
Practice Address - Fax:626-226-4906
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty