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General NPI Number Information
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NPI Number | 1770494452
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Entity Type | Individual
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Provider Name | JESSICA LYNN SANDVIG
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Gender | Female
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 3291 BUCKMAN SPRINGS RD
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City | PINE VALLEY
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State | CA
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Zip | 91962-4003
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Country | US
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Telephone | 619-473-8601
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1534
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City | PINE VALLEY
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State | CA
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Zip | 91962-1534
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Country | US
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Telephone | 619-729-8067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 95028682
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License Number State | CA
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