Healthcare Provider Details

I. General information

NPI: 1316148489
Provider Name (Legal Business Name): SANDRA GALE COLVARD N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 SORRENTO VALLEY RD STE 225
SAN DIEGO CA
92121-1601
US

IV. Provider business mailing address

10505 SORRENTO VALLEY RD STE 225
SAN DIEGO CA
92121-1601
US

V. Phone/Fax

Practice location:
  • Phone: 619-345-3111
  • Fax:
Mailing address:
  • Phone: 703-201-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number06-958
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberJ0000032
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1226
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0990069384
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: