Provider Demographics
NPI:1013461722
Name:SANDO, JESSICA FERNANDEZ
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FERNANDEZ
Last Name:SANDO
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 1:326 ANNAJEANNE DR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3444
Mailing Address - Country:US
Mailing Address - Phone:562-631-7077
Mailing Address - Fax:
Practice Address - Street 1:326 ANNAJEANNE DR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3444
Practice Address - Country:US
Practice Address - Phone:562-631-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW796811041C0700X
390200000X
CA1151731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program