Healthcare Provider Details

I. General information

NPI: 1659744241
Provider Name (Legal Business Name): LEONA SANDRIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 N EUCLID AVE
ONTARIO CA
91762-3456
US

IV. Provider business mailing address

437 N EUCLID AVE
ONTARIO CA
91762-3456
US

V. Phone/Fax

Practice location:
  • Phone: 909-988-2555
  • Fax: 909-988-4447
Mailing address:
  • Phone: 909-988-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: