Healthcare Provider Details

I. General information

NPI: 1598120453
Provider Name (Legal Business Name): ASHLEY MARIE BLUNDELL-SANDERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2015
Last Update Date: 12/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 19TH ST
COSTA MESA CA
92627-5060
US

IV. Provider business mailing address

601 W 19TH ST
COSTA MESA CA
92627-5060
US

V. Phone/Fax

Practice location:
  • Phone: 714-922-4100
  • Fax: 949-548-9051
Mailing address:
  • Phone: 714-922-4100
  • Fax: 949-548-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number823718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: