Provider Demographics
NPI:1609400274
Name:SANDOVAL, ANDREA MICHELL (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELL
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 E 169TH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1102
Mailing Address - Country:US
Mailing Address - Phone:310-330-6955
Mailing Address - Fax:
Practice Address - Street 1:32382 DEL OBISPO ST STE B5
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-4029
Practice Address - Country:US
Practice Address - Phone:424-224-9569
Practice Address - Fax:949-272-8313
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-23
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor