| Doctor Name: | MS. SANDRA SUZANNA CORNEJO |
| NPI Number: | 1316069180 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | CALPU1-224-101111S |
| Business Practice Address: | 68625 Perez Rd Ste 11a Cathedral City, CA - 922347250 |
| Business Phone Number: | 7607736767 |
| Business Fax Number: | 7607736760 |
| Mailing Address: | 68625 Perez Rd Ste 11a, CATHEDRAL CITY |
| State: | CA |
| Postal Code: | 922347250 |
| Phone Number: | 7607736767 |
| Fax Number: | 7607736760 |
| NPI Enumeration Date: | 04/04/2007 |
| NPI Last Update Date: | 12/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CALPU1-224-101111S |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |