Provider Demographics
NPI:1740168202
Name:SANDOVAL, JESSICA ANNE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:SANDOVAL
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 1:1023 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2902
Mailing Address - Country:US
Mailing Address - Phone:707-920-1088
Mailing Address - Fax:
Practice Address - Street 1:1023 PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-2902
Practice Address - Country:US
Practice Address - Phone:707-920-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-23
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95086327163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatalGroup - Multi-Specialty