Healthcare Provider Details

I. General information

NPI: 1871427757
Provider Name (Legal Business Name): PHOENIX SANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SAN PABLO AVE APT 102
BERKELEY CA
94702-2260
US

IV. Provider business mailing address

2700 SAN PABLO AVE APT 102
BERKELEY CA
94702-2260
US

V. Phone/Fax

Practice location:
  • Phone: 510-417-0551
  • Fax:
Mailing address:
  • Phone: 510-417-0551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA CANTERO
Title or Position: OWNER
Credential:
Phone: 510-417-0551