Provider Demographics
NPI:1346136793
Name:SANDRE, JULIETA
Entity type:Individual
Prefix:
First Name:JULIETA
Middle Name:
Last Name:SANDRE
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 1:1146 NADEAU ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-3334
Mailing Address - Country:US
Mailing Address - Phone:323-835-7318
Mailing Address - Fax:
Practice Address - Street 1:1000 N ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1804
Practice Address - Country:US
Practice Address - Phone:213-522-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker