Provider Demographics
NPI:1629474051
Name:SANDOVAL, DELSY MARIA (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:DELSY
Middle Name:MARIA
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18541 DEARBORN ST APT 10
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3045
Mailing Address - Country:US
Mailing Address - Phone:818-983-1716
Mailing Address - Fax:
Practice Address - Street 1:11565 LAUREL CANYON BLVD STE 116
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4650
Practice Address - Country:US
Practice Address - Phone:818-361-5030
Practice Address - Fax:848-361-1764
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner