Provider Demographics
NPI:1235328907
Name:SANDOVAL, DANNY FERNANDO
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:FERNANDO
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E. WARDLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-981-9392
Mailing Address - Fax:562-981-2622
Practice Address - Street 1:850 E. WARDLOW ROAD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-981-9392
Practice Address - Fax:562-981-2622
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health