Healthcare Provider Details

I. General information

NPI: 1104984475
Provider Name (Legal Business Name): SARNDRA GAYE DRIES LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 AVALON DR
VISTA CA
92084-6210
US

IV. Provider business mailing address

1782 TROY LN
OCEANSIDE CA
92054-5648
US

V. Phone/Fax

Practice location:
  • Phone: 760-271-5543
  • Fax:
Mailing address:
  • Phone: 760-439-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN213705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: