Individual
BRYAN SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
499 LOMA ALTA AVE, LOS GATOS, CA 95030-6227
(408) 335-1911
(408) 335-1910
Mailing address
499 LOMA ALTA AVE, LOS GATOS, CA 95030-6227
(408) 335-1911
(408) 335-1910
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4750
SANTA CLARA COUNTY ID#
CA
Enumeration date
11/29/2006
Last updated
07/08/2007
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