Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1013490630 |
---|---|
Provider Name | Viridiana Sandoval |
First Address | Downey, CA 90242-4628 |
Second Address | Huntington Park, CA 90255-4138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2018 |
Last Update Date | 10/09/2018 |