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NPI Code Detail

MEDICARE: MS. SANDRA GABRIELA CARRANZA AGUILAR

MEDICARE: MS. SANDRA GABRIELA CARRANZA AGUILAR
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1710046537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SANDRA GABRIELA CARRANZA AGUILAR
Provider Business Mailing Address
First Line : 1465 30TH ST STE K
Second Line :
City : SAN DIEGO
State : CA
Zip : 92154-3497
Country : US
Telephone Number : 619-428-1000
Fax Number :
Provider Business Practice Location Address
First Line : 7146 BROADWAY
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-1401
Country : US
Telephone Number : 619-906-5321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2006
Last Update Date : 03/09/2020

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