Provider Demographics
NPI:1316148489
Name:COLVARD, SANDRA GALE (ND)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:GALE
Last Name:COLVARD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 SORRENTO VALLEY RD STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1601
Mailing Address - Country:US
Mailing Address - Phone:703-201-0746
Mailing Address - Fax:
Practice Address - Street 1:10505 SORRENTO VALLEY RD STE 225
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1601
Practice Address - Country:US
Practice Address - Phone:619-345-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-958175F00000X
MDJ0000032175F00000X
CA1226175F00000X
VT0990069384175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath