Healthcare Provider Details

I. General information

NPI: 1194402297
Provider Name (Legal Business Name): SANDRA URANIA MERINO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA MERINO URANIA MENJIVAR NP

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CAHUENGA BLVD W STE 505
LOS ANGELES CA
90068-1355
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-501-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95025458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: