Provider Demographics
NPI:1770397267
Name:SANDOVAL, KARINA ALEXA
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:ALEXA
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15653 W SAN JOAQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1380
Mailing Address - Country:US
Mailing Address - Phone:559-755-1342
Mailing Address - Fax:
Practice Address - Street 1:5610 W DONNER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3721
Practice Address - Country:US
Practice Address - Phone:559-352-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist