Healthcare Provider Details

I. General information

NPI: 1689507410
Provider Name (Legal Business Name): SANDRA MARIA LONSDALE-CAMPO MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E ASHTABULA ST
PASADENA CA
91104-4399
US

IV. Provider business mailing address

14063 FENTON LN
SYLMAR CA
91342-1656
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-5780
  • Fax:
Mailing address:
  • Phone: 818-396-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: