Individual
SANDIE DUBOIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11553 FOOTHILL BLVD STE 101, RANCHO CUCAMONGA, CA 91730-0731
(909) 961-8339
Mailing address
10210 BASELINE RD SPC 267, ALTA LOMA, CA 91701-6048
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1744P3200X
Prosthetics Case Management
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KK347413
COSMETOLOGY LICENSE
CA
Enumeration date
03/08/2020
Last updated
03/08/2020
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