Provider Demographics
NPI:1255204517
Name:LLANEZA, DAVID SANDOVAL (RN BSN PHN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SANDOVAL
Last Name:LLANEZA
Suffix:
Gender:M
Credentials:RN BSN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SAN LEANDRO BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1595
Mailing Address - Country:US
Mailing Address - Phone:510-667-3096
Mailing Address - Fax:
Practice Address - Street 1:1100 SAN LEANDRO BLVD FL 3
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1595
Practice Address - Country:US
Practice Address - Phone:510-667-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561631163W00000X
CA95086159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty