Provider Demographics
NPI:1134945868
Name:SANDLIN, ANGEL LATIAA (MA, BA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:LATIAA
Last Name:SANDLIN
Suffix:
Gender:F
Credentials:MA, BA
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:LATIAA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BA
Mailing Address - Street 1:10166 BEACHCOMBER ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2869
Mailing Address - Country:US
Mailing Address - Phone:760-662-1089
Mailing Address - Fax:
Practice Address - Street 1:300 S PARK AVE STE 750
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1553
Practice Address - Country:US
Practice Address - Phone:909-575-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist