Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1043772502 |
---|---|
Provider Name | Miss Angie Ann Sandoval |
First Address | Pomona, CA 91767-2722 |
Second Address | Pomona, CA 91767-2722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 03/04/2019 |