MEDICARE: HEATHER SANDS NP

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	363L00000X	Nurse Practitioner	NP6216	CA

General Provider Information

NPI Number	:	1619902194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER SANDS NP

Provider Business Mailing Address
First Line	:	1720 E CESAR E CHAVEZ AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-2414
Country	:	US
Telephone Number	:	323-268-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3261 VETERAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3038
Country	:	US
Telephone Number	:	310-804-4967
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/06/2012

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