Healthcare Provider Details

I. General information

NPI: 1679378103
Provider Name (Legal Business Name): LIDYA ALSANADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 PARKSIDE DR
FREMONT CA
94536-5246
US

IV. Provider business mailing address

31373 BRAE BURN AVE
HAYWARD CA
94544-7625
US

V. Phone/Fax

Practice location:
  • Phone: 510-793-7492
  • Fax:
Mailing address:
  • Phone: 510-386-8435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number95128819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: