Healthcare Provider Details

I. General information

NPI: 1821836669
Provider Name (Legal Business Name): SANDRA SHERIF LOZA-QOBORSI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA SHERIF LOZA PH.D.

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 S COAST DR STE 225
COSTA MESA CA
92626-7757
US

IV. Provider business mailing address

102 VIA VELAZQUEZ
SAN CLEMENTE CA
92672-3878
US

V. Phone/Fax

Practice location:
  • Phone: 949-743-1457
  • Fax: 949-274-8299
Mailing address:
  • Phone: 949-992-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: