Provider Demographics
NPI:1164757522
Name:JA'CHIM, SANDRA (FNP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:JA'CHIM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 N BROADWAY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3852
Mailing Address - Country:US
Mailing Address - Phone:925-932-7715
Mailing Address - Fax:925-932-0603
Practice Address - Street 1:1981 N BROADWAY
Practice Address - Street 2:SUITE 190
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3852
Practice Address - Country:US
Practice Address - Phone:925-932-7715
Practice Address - Fax:925-932-0603
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily