Basic Information
| Provider Information | |||||||||
| NPI: | 1306103908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDOVAL | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | BEATRIZ | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 624 COMMERCE AVE STE E | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935513883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612152749 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16946 SHERMAN WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914063613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182351414 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2012 | ||||||||
| LastUpdateDate: | 04/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-11-8000 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.