Most Relevant Information
Provider Data
| NPI Number: | 1003697541 |
| Provider Name: | KELVIN ENRRIQUE SANDOVAL |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/11/2023 |
| Last Updated: | 10/11/2023 |
Provider Practice Location
2625 TOWNSGATE RD STE 102
WESTLAKE VILLAGE
CA
913615726
Practice Location Phone/Fax
| Phone: | 8054133009 |
| Fax: |
Provider Mailing Location
19223 SATICOY ST APT 37
RESEDA
CA
913352552
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |