Provider Demographics
NPI:1609926062
Name:KLEIN, SANDRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOVE ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3023
Mailing Address - Country:US
Mailing Address - Phone:562-400-8603
Mailing Address - Fax:
Practice Address - Street 1:901 DOVE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3023
Practice Address - Country:US
Practice Address - Phone:562-400-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13918103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY13918OtherSTATE LICENSE
CACP13918Medicare ID - Type UnspecifiedMEDICARE ID #