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General NPI Number Information
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NPI Number | 1265379994
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Entity Type | Organization
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Legal Business Name | WEASPORA SPC
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Dates
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Enumeration Date | 04/30/2026
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Last Update Date | 04/30/2026
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Provider Practice Location Address
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Address Line | 8623 S VERMONT AVE APT 6
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City | LOS ANGELES
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State | CA
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Zip | 90044-4855
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Country | US
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Telephone | 323-781-5238
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Fax |
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Provider Business Mailing Address
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Address Line | 8623 S VERMONT AVE APT 6
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City | LOS ANGELES
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State | CA
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Zip | 90044-4855
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Country | US
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Telephone | 323-781-5238
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. SUTIWEYU SANDOVAL
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Credential |
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Telephone | 323-781-5238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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