Provider Demographics
NPI:1639202807
Name:SANDOVAL, KASIRAPA PATSY (PSYD)
Entity Type:Individual
Prefix:
First Name:KASIRAPA
Middle Name:PATSY
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KASIRAPA
Other - Middle Name:PATSY
Other - Last Name:KHEMTONGPRU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 W. MAIN ST.
Mailing Address - Street 2:STE. C #326
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:626-548-8479
Mailing Address - Fax:
Practice Address - Street 1:130 COOK AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3390
Practice Address - Country:US
Practice Address - Phone:626-808-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical