Provider Demographics
NPI:1740593748
Name:SANDOVAL, LISA CAROL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 E PALMDALE BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-5038
Mailing Address - Country:US
Mailing Address - Phone:661-274-8454
Mailing Address - Fax:661-274-7614
Practice Address - Street 1:3166 E PALMDALE BLVD STE 112
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-5038
Practice Address - Country:US
Practice Address - Phone:661-274-8454
Practice Address - Fax:661-274-7614
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist