Healthcare Provider Details

I. General information

NPI: 1881012896
Provider Name (Legal Business Name): DOLORES CRUZ SANDOVAL LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E. MINARETS
PINEDALE CA
93650
US

IV. Provider business mailing address

40 E. MINARETS
PINEDALE CA
93650
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-0482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number207226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: