Provider Demographics
NPI:1912243007
Name:SANDOVAL, ROBERTO SOSA
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:SOSA
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18553 ARMINTA ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1834
Mailing Address - Country:US
Mailing Address - Phone:818-342-5897
Mailing Address - Fax:818-975-5008
Practice Address - Street 1:18553 ARMINTA ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1834
Practice Address - Country:US
Practice Address - Phone:818-342-5897
Practice Address - Fax:818-975-5008
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)