Provider Demographics
NPI:1730219379
Name:PINON-CHAVEZ, SANDRA ALICIA (MS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ALICIA
Last Name:PINON-CHAVEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90633-1132
Mailing Address - Country:US
Mailing Address - Phone:626-965-4463
Mailing Address - Fax:
Practice Address - Street 1:18780 AMAR RD STE 204
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4559
Practice Address - Country:US
Practice Address - Phone:626-965-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46298106H00000X
MFC47630106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist