Healthcare Provider Details

I. General information

NPI: 1083737258
Provider Name (Legal Business Name): URMILA SANDHU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BRANSCOMB RD
LAYTONVILLE CA
95454
US

IV. Provider business mailing address

PO BOX 870
LAYTONVILLE CA
95454-0870
US

V. Phone/Fax

Practice location:
  • Phone: 707-984-6131
  • Fax: 707-984-7337
Mailing address:
  • Phone: 707-984-6131
  • Fax: 707-984-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: