Provider Demographics
NPI:1881078988
Name:DESGREY, SANDRA A (FNP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:DESGREY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 AGOURA RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3101
Mailing Address - Country:US
Mailing Address - Phone:858-222-3232
Mailing Address - Fax:
Practice Address - Street 1:2791 AGOURA RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-3101
Practice Address - Country:US
Practice Address - Phone:805-495-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1965363LF0000X
CA95002629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily