Provider Demographics
NPI:1184293482
Name:SANDOVAL, SAVANAH DAVINA (BHT)
Entity type:Individual
Prefix:
First Name:SAVANAH
Middle Name:DAVINA
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 E BASELINE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2465
Mailing Address - Country:US
Mailing Address - Phone:480-306-8466
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 300
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2465
Practice Address - Country:US
Practice Address - Phone:480-306-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZABAOtherBCBS