Healthcare Provider Details

I. General information

NPI: 1255409249
Provider Name (Legal Business Name): SANDRA LEPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 E SLAUSON AVE
COMMERCE CA
90040-2953
US

IV. Provider business mailing address

PO BOX 2912
BELL GARDENS CA
90202-2912
US

V. Phone/Fax

Practice location:
  • Phone: 213-972-7000
  • Fax:
Mailing address:
  • Phone: 562-656-8730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: