Provider Demographics
NPI:1639975162
Name:GUADAN, SANDY MARTINEZ (FNP-BC)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:MARTINEZ
Last Name:GUADAN
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:GUADAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30 CARNOUSTIE WAY
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-5025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 CARNOUSTIE WAY
Practice Address - Street 2:
Practice Address - City:COTO DE CAZA
Practice Address - State:CA
Practice Address - Zip Code:92679-5025
Practice Address - Country:US
Practice Address - Phone:714-454-7339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034088363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care