Provider Demographics
NPI:1235324294
Name:SANDOVAL, CRISTINA CLARISSA (MS, CCC SLP)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:CLARISSA
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MS, CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-3309
Mailing Address - Country:US
Mailing Address - Phone:956-289-2314
Mailing Address - Fax:
Practice Address - Street 1:411 N 8TH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-3309
Practice Address - Country:US
Practice Address - Phone:956-289-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist