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NPI Code Detail

MEDICARE: SANDRA C CESPEDES SUDRC 1

MEDICARE: SANDRA C CESPEDES SUDRC 1
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1003743006
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA C CESPEDES SUDRC 1
Provider Business Mailing Address
First Line : 2403 PROFESSIONAL DR STE 101
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-3007
Country : US
Telephone Number : 707-544-3295
Fax Number :
Provider Business Practice Location Address
First Line : 790 SONOMA AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95404-4713
Country : US
Telephone Number : 707-544-3295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

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Directions to “ SANDRA C CESPEDES SUDRC 1” Practice Location

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