MEDICARE: LUCINA SANDOVAL-GORDON

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
1	1041C0700X	Clinical Social Worker	120131	CA
2	104100000X	Social Worker	120131	CA

General Provider Information

NPI Number	:	1780711689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCINA SANDOVAL-GORDON

Provider Business Mailing Address
First Line	:	3762 SHAFTER AVE APT 4
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-2775
Country	:	US
Telephone Number	:	510-384-3976
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 E 12TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-3424
Country	:	US
Telephone Number	:	510-269-9030
Fax Number	:	510-269-9031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	05/23/2025

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Directions to “ LUCINA SANDOVAL-GORDON ” Practice Location

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