Provider Demographics
NPI:1932970316
Name:SANDOVAL, VALERIE DELOREN (SUDRC)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:DELOREN
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 4TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3435
Mailing Address - Country:US
Mailing Address - Phone:818-987-1798
Mailing Address - Fax:
Practice Address - Street 1:1244 4TH AVE APT 7
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3435
Practice Address - Country:US
Practice Address - Phone:818-987-1798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13505106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician