Healthcare Provider Details

I. General information

NPI: 1851477244
Provider Name (Legal Business Name): SANDRA JANE ROBERTSON RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

3139 PURDUE AVE
LOS ANGELES CA
90066-1405
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone: 310-980-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number601686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: