Healthcare Provider Details

I. General information

NPI: 1205042611
Provider Name (Legal Business Name): SANDRA G SCHARFFENBERG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24250 N BUCK RD
ACAMPO CA
95220-9613
US

IV. Provider business mailing address

PO BOX 520
ACAMPO CA
95220-0520
US

V. Phone/Fax

Practice location:
  • Phone: 209-368-8281
  • Fax:
Mailing address:
  • Phone: 209-368-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number484027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: