Healthcare Provider Details

I. General information

NPI: 1093014029
Provider Name (Legal Business Name): SANDRA SASSO NMW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 WILSHIRE BLVD FL 3
LOS ANGELES CA
90057-3519
US

IV. Provider business mailing address

2011 WILSHIRE BLVD STE 300
LOS ANGELES CA
90057-3503
US

V. Phone/Fax

Practice location:
  • Phone: 213-205-1890
  • Fax: 137-580-0642
Mailing address:
  • Phone: 213-205-1890
  • Fax: 213-758-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number731
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: