Healthcare Provider Details

I. General information

NPI: 1437446390
Provider Name (Legal Business Name): ARELIS MANJARREZ SANDOVAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARELIS MANJARREZ RN

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SAN LEANDRO BLVD
SAN LEANDRO CA
94577-1595
US

IV. Provider business mailing address

1100 SAN LEANDRO BLVD
SAN LEANDRO CA
94577-1595
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-4267
  • Fax: 510-267-3212
Mailing address:
  • Phone: 510-481-4267
  • Fax: 510-618-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026543
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number673733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: