Provider Demographics
NPI:1518796168
Name:SANDOVAL, HAILEY NICOLE (HIS)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:NICOLE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33050 ANTELOPE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2491
Mailing Address - Country:US
Mailing Address - Phone:951-925-8100
Mailing Address - Fax:
Practice Address - Street 1:33050 ANTELOPE RD STE 205
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2491
Practice Address - Country:US
Practice Address - Phone:951-925-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA9023237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty