Individual provider Active NPI

Sandra Lynn Erdelac, LMFT

  • Marriage & Family Therapist
  • Norwalk, CA
National Provider Identifier
1659494664
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT47800 Issued in CA
Practice address
12501 Imperial Hwy Ste 400
Norwalk, CA 90650-1419
Phone
(818) 807-6100
Fax
(562) 807-6111
NPI assigned
Apr 6, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X LMFT47800 CA Primary

Addresses

Primary practice location

12501 Imperial Hwy Ste 400
Norwalk, CA 90650-1419

Mailing address

12501 Imperial Hwy Ste 400
Norwalk, CA 90650-1419
Phone (818) 807-6100

Other names 1

  • Miss Sandra Lynn Botello Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240610001379 CA Practitioner - Marriage and Family Therapist 0840732517 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMFT47800CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Apr 29, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Grow Healthcare Group PC Marriage & Family Therapist CurrentSince Nov 1, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 29, 2024 Accepting new patients

Locations

9333 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-3184

12501 Imperial Hwy
Ste 400
Norwalk, CA 90650
Phone (562) 807-6100

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1659494664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12501 IMPERIAL HWY STE 400",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906501419",
            "telephone_number": "818-807-6100",
            "fax_number": "562-807-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12501 IMPERIAL HWY STE 400",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906501419",
            "telephone_number": "818-807-6100",
            "fax_number": "562-807-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERDELAC",
        "first_name": "SANDRA",
        "middle_name": "LYNN",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT47800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "BOTELLO",
            "middle_name": "LYNN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Norwalk, CA

Sources for this page

Verify at the official NPI Registry.