Healthcare Provider Details

I. General information

NPI: 1326913252
Provider Name (Legal Business Name): SANDRA SLOAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 WOODLEY AVE
ENCINO CA
91436-1443
US

IV. Provider business mailing address

PO BOX 9122
MARINA DEL REY CA
90295-1522
US

V. Phone/Fax

Practice location:
  • Phone: 628-432-7476
  • Fax:
Mailing address:
  • Phone: 310-721-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: