Healthcare Provider Details

I. General information

NPI: 1962134692
Provider Name (Legal Business Name): SANDRA KAMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 EL CAMINO AVE
SACRAMENTO CA
95815-2530
US

IV. Provider business mailing address

7708 E PORT DR
SACRAMENTO CA
95831-5613
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-1867
  • Fax:
Mailing address:
  • Phone: 323-620-6484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95065306
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95021536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: