Basic Information
| Provider Information | |||||||||
| NPI: | 1851720544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LLAMAS | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | PATRICIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.A. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 WILSHIRE BLVD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900102632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133824400 | ||||||||
| FaxNumber: | 2133824494 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 WILSHIRE BLVD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900102632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133824400 | ||||||||
| FaxNumber: | 2133824494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 1851720544 | 05 | CA | MEDICAID |