Provider Demographics
NPI:1689703654
Name:SANDOVAL, REGINA (RN, PHN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4858
Mailing Address - Country:US
Mailing Address - Phone:858-490-4424
Mailing Address - Fax:858-490-4479
Practice Address - Street 1:2440 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4858
Practice Address - Country:US
Practice Address - Phone:858-490-4424
Practice Address - Fax:858-490-4479
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA622957163WC1500X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn