Provider Demographics
NPI:1881466753
Name:GLEASON, SANDRA (NBC-HWC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GLEASON
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:592 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2212
Mailing Address - Country:US
Mailing Address - Phone:310-614-8294
Mailing Address - Fax:
Practice Address - Street 1:592 29TH ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2212
Practice Address - Country:US
Practice Address - Phone:310-614-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach