Basic Information
| Provider Information | |||||||||
| NPI: | 1497225593 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDOVAL | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | DEL. CARMEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27006 JENNINGS WAY | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945444342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103149696 | ||||||||
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| Practice Location | |||||||||
| Address1: | 545 ESTUDILLO AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945774611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107467480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2018 | ||||||||
| LastUpdateDate: | 11/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.