Basic Information
| Provider Information | |||||||||
| NPI: | 1588854889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDOVAL | ||||||||
| FirstName: | SHARLENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6635 FLORENCE AVE | ||||||||
| Address2: | |||||||||
| City: | BELL GARDENS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902014909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236476740 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6635 FLORENCE AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | BELL GARDENS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236476740 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 12/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 103TC0700X | 32029 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.