Healthcare Provider Details

I. General information

NPI: 1922123819
Provider Name (Legal Business Name): SANDRA LYN ELVIK R.N., C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

28653 VISTA MADERA
RANCHO PALOS VERDES CA
90275-0870
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3567
  • Fax: 310-320-7849
Mailing address:
  • Phone: 310-732-1334
  • Fax: 310-320-7849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN293250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: