Provider Demographics
NPI:1720593171
Name:VANDERWOUDE, SANDRA JOY
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JOY
Last Name:VANDERWOUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 HAVENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-9390
Mailing Address - Country:US
Mailing Address - Phone:209-204-5874
Mailing Address - Fax:
Practice Address - Street 1:500 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5814
Practice Address - Country:US
Practice Address - Phone:209-525-7412
Practice Address - Fax:209-558-4371
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator