Healthcare Provider Details

I. General information

NPI: 1851453526
Provider Name (Legal Business Name): SANDRA SILVA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 ENTERPRISE DR BLDG 2 # MS 2-270
FAIRFIELD CA
94533-5801
US

IV. Provider business mailing address

1520 ROSEBERRY CT
DIXON CA
95620-4105
US

V. Phone/Fax

Practice location:
  • Phone: 707-399-4946
  • Fax: 707-399-4957
Mailing address:
  • Phone: 707-693-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC41656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: