Provider Demographics
NPI:1396528931
Name:BLACKWOOD, SANDRA (CD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:BLACKWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD
Mailing Address - Street 1:3881 GROTON ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5632
Mailing Address - Country:US
Mailing Address - Phone:619-261-1357
Mailing Address - Fax:
Practice Address - Street 1:3881 GROTON ST UNIT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5632
Practice Address - Country:US
Practice Address - Phone:619-261-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula