Healthcare Provider Details

I. General information

NPI: 1679789606
Provider Name (Legal Business Name): SANDRA S GARCIA RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W SUNSET BLVD
LOS ANGELES CA
90027-5814
US

IV. Provider business mailing address

1878 LOS ENCINOS AVE
GLENDALE CA
91208-2240
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-4345
  • Fax: 323-783-8188
Mailing address:
  • Phone: 818-241-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number456582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: