Healthcare Provider Details

I. General information

NPI: 1972153625
Provider Name (Legal Business Name): JAMIE ALONDRA SARCENO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2019
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18523 CORWIN RD STE E
APPLE VALLEY CA
92307-2300
US

IV. Provider business mailing address

19111 TOWN CENTER DR
APPLE VALLEY CA
92308-8989
US

V. Phone/Fax

Practice location:
  • Phone: 760-204-2122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number0001242637
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178058
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: