Provider Demographics
NPI:1710762703
Name:CARBAJAL, SANDRA LIZETH (M ED)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LIZETH
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 W 39TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-5552
Mailing Address - Country:US
Mailing Address - Phone:928-315-3006
Mailing Address - Fax:
Practice Address - Street 1:3442 W 39TH PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-5552
Practice Address - Country:US
Practice Address - Phone:928-315-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLPA-59582355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant