Healthcare Provider Details

I. General information

NPI: 1033080973
Provider Name (Legal Business Name): SANDRA MALONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

29302 LARO DR
AGOURA HILLS CA
91301-1608
US

V. Phone/Fax

Practice location:
  • Phone: 805-366-4341
  • Fax:
Mailing address:
  • Phone: 201-978-0684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: