MEDICARE: SANDY SARAH GORDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1174271829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY SARAH GORDON

Provider Business Mailing Address
First Line	:	8921 GLENDON WAY APT 1
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-1858
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3835
Country	:	US
Telephone Number	:	323-487-9003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2022
Last Update Date	:	03/11/2022

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Directions to “ SANDY SARAH GORDON ” Practice Location

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