Healthcare Provider Details

I. General information

NPI: 1386820116
Provider Name (Legal Business Name): SANDRA FRUCHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 YGNACIO VALLEY RD STE 102A
WALNUT CREEK CA
94596-3818
US

IV. Provider business mailing address

3494 SPRINGHILL CT
LAFAYETTE CA
94549-2333
US

V. Phone/Fax

Practice location:
  • Phone: 510-273-9315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: