Healthcare Provider Details

I. General information

NPI: 1649398520
Provider Name (Legal Business Name): SANDRA LUZ MESSINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA LUZ RUVALCABA

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 BROCKTON AVE STE 9
RIVERSIDE CA
92506-3816
US

IV. Provider business mailing address

6860 BROCKTON AVE STE 9
RIVERSIDE CA
92506-3816
US

V. Phone/Fax

Practice location:
  • Phone: 951-224-9940
  • Fax:
Mailing address:
  • Phone: 951-224-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: