Provider Demographics
NPI:1437446390
Name:SANDOVAL, ARELIS MANJARREZ (RN)
Entity Type:Individual
Prefix:
First Name:ARELIS
Middle Name:MANJARREZ
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ARELIS
Other - Middle Name:
Other - Last Name:MANJARREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1100 SAN LEANDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1595
Mailing Address - Country:US
Mailing Address - Phone:510-481-4267
Mailing Address - Fax:510-618-1973
Practice Address - Street 1:1100 SAN LEANDRO BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1595
Practice Address - Country:US
Practice Address - Phone:510-481-4267
Practice Address - Fax:510-267-3212
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026543363LF0000X
CA673733163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily