| Doctor Name: | TIFFANY SANDOVAL |
| NPI Number: | 1285032276 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CMT |
| License Number: | 46521 |
| Business Practice Address: | 30220 Rancho Viejo Rd Suite #e San Juan Capistrano, CA - 926751568 |
| Business Phone Number: | 9498384436 |
| Business Fax Number: | 8002696304 |
| Mailing Address: | 30220 Rancho Viejo Rd, Suite #e SAN JUAN CAPISTRANO |
| State: | CA |
| Postal Code: | 926751568 |
| Phone Number: | 9498384436 |
| Fax Number: | 8002696304 |
| NPI Enumeration Date: | 12/08/2014 |
| NPI Last Update Date: | 12/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 46521 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |