Provider Demographics
NPI:1962273508
Name:SANDOVAL, ROBERT MARK (CATC III)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MARK
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:CATC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RAMONA EXPY
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7014
Mailing Address - Country:US
Mailing Address - Phone:626-348-1441
Mailing Address - Fax:
Practice Address - Street 1:85 RAMONA EXPY
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571
Practice Address - Country:US
Practice Address - Phone:626-348-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2114095-II101YA0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)