Provider Demographics
NPI:1942195250
Name:SANDOVAL, BRENDA RANAE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:RANAE
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 1:3535 PLAINSMAN LN APT F82
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3833
Mailing Address - Country:US
Mailing Address - Phone:863-445-1615
Mailing Address - Fax:
Practice Address - Street 1:3535 PLAINSMAN LN APT F82
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3833
Practice Address - Country:US
Practice Address - Phone:863-445-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician