Provider Demographics
NPI:1053690990
Name:SANDOVAL, LESLIE (CD(DONA))
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23144 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3820
Mailing Address - Country:US
Mailing Address - Phone:949-235-9834
Mailing Address - Fax:
Practice Address - Street 1:23144 VISTA WAY
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3820
Practice Address - Country:US
Practice Address - Phone:949-235-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula