Basic Information
| Provider Information | |||||||||
| NPI: | 1467909515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDOVAL | ||||||||
| FirstName: | LORENZO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 471 | ||||||||
| Address2: | |||||||||
| City: | KERMAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936300471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593555381 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7486 N PALM AVENUE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592218100 | ||||||||
| FaxNumber: | 5592218101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2016 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.