Individual
ANIVAL SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4445 BURNS AVE, LOS ANGELES, CA 90029-2702
(323) 222-1440
Mailing address
4445 BURNS AVE, LOS ANGELES, CA 90029-2702
(323) 222-1440
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6758
—
CA
05
—
7068
—
CA
05
—
7420
—
CA
Enumeration date
07/15/2016
Last updated
09/30/2022
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