Healthcare Provider Details

I. General information

NPI: 1356713739
Provider Name (Legal Business Name): SASHA GISELLE LLAMAS SOCIAL WORK INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 MORENA BLVD
SAN DIEGO CA
92110-3815
US

IV. Provider business mailing address

1250 MORENA BLVD
SAN DIEGO CA
92110-3815
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8750
  • Fax:
Mailing address:
  • Phone: 619-692-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number94249
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: