Provider Demographics
NPI:1912471343
Name:KORDICH-SANDOVAL, ANNA MARIE (AMFT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:KORDICH-SANDOVAL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9685 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3660
Mailing Address - Country:US
Mailing Address - Phone:951-351-4418
Mailing Address - Fax:
Practice Address - Street 1:9685 HAYES ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3660
Practice Address - Country:US
Practice Address - Phone:951-351-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty