Healthcare Provider Details

I. General information

NPI: 1780249383
Provider Name (Legal Business Name): MANSIMRAN SANDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11934 ROQUEFORT WAY
RANCHO CORDOVA CA
95742-6938
US

IV. Provider business mailing address

11934 ROQUEFORT WAY
RANCHO CORDOVA CA
95742-6938
US

V. Phone/Fax

Practice location:
  • Phone: 925-967-7026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95037467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: