Provider Demographics
NPI:1407238710
Name:MINTZ, SANDRA (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MINTZ
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 ADOLFO RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-6792
Mailing Address - Country:US
Mailing Address - Phone:805-437-1380
Mailing Address - Fax:805-389-4297
Practice Address - Street 1:5100 ADOLFO RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-6792
Practice Address - Country:US
Practice Address - Phone:805-437-1380
Practice Address - Fax:805-389-4297
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2601231H00000X, 231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner