Provider Demographics
NPI:1578079760
Name:SANDOVAL, YARELI (RBT)
Entity Type:Individual
Prefix:MISS
First Name:YARELI
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 S 8TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7154
Mailing Address - Country:US
Mailing Address - Phone:928-782-1338
Mailing Address - Fax:
Practice Address - Street 1:2741 S 8TH AVE STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7154
Practice Address - Country:US
Practice Address - Phone:928-782-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-21425106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty