Provider Demographics
NPI:1245460062
Name:LEAL-LOPEZ, SANDRA (MA MFT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:LEAL-LOPEZ
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:LEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:12669 ENCINITAS AVE
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3635
Mailing Address - Country:US
Mailing Address - Phone:800-700-8705
Mailing Address - Fax:
Practice Address - Street 1:12669 ENCINITAS AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3635
Practice Address - Country:US
Practice Address - Phone:800-700-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT83637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist