Provider Demographics
NPI:1487218301
Name:SANDOVAL, VERONICA KAY
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:KAY
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:KAY
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7400 ARTESIA BLVD APT 603
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1899
Mailing Address - Country:US
Mailing Address - Phone:714-333-5302
Mailing Address - Fax:
Practice Address - Street 1:3850 E ESTHER ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2009
Practice Address - Country:US
Practice Address - Phone:562-498-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2705225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant