Provider Demographics
NPI:1902450620
Name:SANDOVAL, BRYAN FELIPE (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:FELIPE
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:8559 SAN JACINTO CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3650 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1502
Practice Address - Country:US
Practice Address - Phone:562-633-6353
Practice Address - Fax:562-633-4996
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA58130363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant