Active NPI
Ricardo Sandoval
- Prevention Professional
- Los Angeles, CA
National Provider Identifier
1811593577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- A5018449
- Practice address
- 5917 Converse Ave
Los Angeles, CA 90001-1409 - Phone
- (323) 423-9030
- NPI assigned
- Dec 8, 2020
- Last updated
- Dec 8, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | A5018449 | CA | Primary |
Addresses
Primary practice location
5917 Converse Ave
Los Angeles, CA 90001-1409
Mailing address
5715 S Broadway
Los Angeles, CA 90037-4131
Phone (323) 948-0444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A5018449 | CA | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607385600000",
"number": "1811593577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5715 S BROADWAY",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900374131",
"telephone_number": "323-948-0444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5917 CONVERSE AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900011409",
"telephone_number": "323-423-9030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDOVAL",
"first_name": "RICARDO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-08",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "CA",
"license": "A5018449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.