Individual provider Active NPI

David Sandoval Llaneza, RN BSN PHN

  • Registered Nurse
  • San Leandro, CA
National Provider Identifier
1255204517
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
95086159 Issued in CA
Practice address
1100 San Leandro Blvd FL 3
San Leandro, CA 94577-1595
Phone
(510) 667-3096
NPI assigned
Sep 24, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X 561631 CA
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X 95086159 CA Primary

Addresses

Primary practice location

1100 San Leandro Blvd FL 3
San Leandro, CA 94577-1595

Mailing address

1100 San Leandro Blvd FL 3
San Leandro, CA 94577-1595
Phone (510) 667-3096

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
561631CAMDRegistered Nurse
95086159CAMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1255204517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SAN LEANDRO BLVD FL 3",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945771595",
            "telephone_number": "510-667-3096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SAN LEANDRO BLVD FL 3",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945771595",
            "telephone_number": "510-667-3096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LLANEZA",
        "first_name": "DAVID",
        "middle_name": "SANDOVAL",
        "name_prefix": "Mr.",
        "credential": "RN BSN PHN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-09-24",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "561631",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95086159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Leandro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.