Healthcare Provider Details

I. General information

NPI: 1700797396
Provider Name (Legal Business Name): MS. MARJANELLY ELIZABETH SOSA GARDUNO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43845 10TH ST W STE 1D
LANCASTER CA
93534-4800
US

IV. Provider business mailing address

PO BOX 1384
LANCASTER CA
93584-1384
US

V. Phone/Fax

Practice location:
  • Phone: 661-727-0061
  • Fax: 661-418-0060
Mailing address:
  • Phone: 213-440-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: