Provider Demographics
NPI:1811235021
Name:ALARCON, SANDRA ESTELA (IMF)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ESTELA
Last Name:ALARCON
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 BUCKWHEAT TRL
Mailing Address - Street 2:
Mailing Address - City:CAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:91906-3157
Mailing Address - Country:US
Mailing Address - Phone:619-674-2465
Mailing Address - Fax:
Practice Address - Street 1:1326 BUCKWHEAT TRL
Practice Address - Street 2:
Practice Address - City:CAMPO
Practice Address - State:CA
Practice Address - Zip Code:91906-3157
Practice Address - Country:US
Practice Address - Phone:619-674-2465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist