Healthcare Provider Details

I. General information

NPI: 1114795374
Provider Name (Legal Business Name): AURORA SUNDERLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 NUGGET AVE
LAKE ISABELLA CA
93240-9456
US

IV. Provider business mailing address

PO BOX 2632
LAKE ISABELLA CA
93240-2632
US

V. Phone/Fax

Practice location:
  • Phone: 760-379-3412
  • Fax: 760-379-5332
Mailing address:
  • Phone: 760-379-3412
  • Fax: 760-379-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: