Provider Demographics
NPI:1437869617
Name:SANDOVAL, CRISTIAN ALEJANDRO (BA, RBT)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:ALEJANDRO
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E HERNDON AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3100
Mailing Address - Country:US
Mailing Address - Phone:559-575-8172
Mailing Address - Fax:
Practice Address - Street 1:215 CENTER ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4408
Practice Address - Country:US
Practice Address - Phone:559-575-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician