Healthcare Provider Details

I. General information

NPI: 1073137139
Provider Name (Legal Business Name): SANDRA LEE OSWALD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6991 BALBOA AVE
SAN DIEGO CA
92111-3447
US

IV. Provider business mailing address

6991 BALBOA AVE
SAN DIEGO CA
92111-3447
US

V. Phone/Fax

Practice location:
  • Phone: 858-496-8232
  • Fax: 858-496-8234
Mailing address:
  • Phone: 858-496-8232
  • Fax: 858-496-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number529846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: