Provider Demographics
NPI:1326512575
Name:ECHEVERRY SANDOVAL, PAULA ANDREA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ANDREA
Last Name:ECHEVERRY SANDOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 STEPPING STONE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-4207
Mailing Address - Country:US
Mailing Address - Phone:949-836-0974
Mailing Address - Fax:
Practice Address - Street 1:93 STEPPING STONE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-4207
Practice Address - Country:US
Practice Address - Phone:949-836-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA109493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst