Provider Demographics
NPI:1023242120
Name:SANDOVAL, REBECA (MD)
Entity type:Individual
Prefix:MS
First Name:REBECA
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 JACKSON DRIVE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-464-1374
Mailing Address - Fax:619-464-1058
Practice Address - Street 1:5360 JACKSON DRIVE, SUITE 100
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-464-1374
Practice Address - Fax:619-464-1058
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107155207V00000X
TN46951207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology