Provider Demographics
NPI:1174331599
Name:SANDOVAL VARGAS, PAULA ANDREA
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ANDREA
Last Name:SANDOVAL VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WELLSPRING TER
Mailing Address - Street 2:
Mailing Address - City:ALLENHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31301-2690
Mailing Address - Country:US
Mailing Address - Phone:954-254-6973
Mailing Address - Fax:
Practice Address - Street 1:79 WELLSPRING TER
Practice Address - Street 2:
Practice Address - City:ALLENHURST
Practice Address - State:GA
Practice Address - Zip Code:31301-2690
Practice Address - Country:US
Practice Address - Phone:954-254-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician