Provider Demographics
NPI:1194402297
Name:MERINO, SANDRA URANIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:URANIA
Last Name:MERINO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:SANDRA MERINO
Other - Middle Name:URANIA
Other - Last Name:MENJIVAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:27622 FIREBRAND DR
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3583
Mailing Address - Country:US
Mailing Address - Phone:323-377-6595
Mailing Address - Fax:
Practice Address - Street 1:27622 FIREBRAND DR
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-3583
Practice Address - Country:US
Practice Address - Phone:323-377-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA957053363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty