MEDICARE: KEISA W SANDERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1174485908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISA W SANDERS

Provider Business Mailing Address
First Line	:	1075 CREEKSIDE RIDGE DR STE 280
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-3504
Country	:	US
Telephone Number	:	916-729-3098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 CURTIS ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1003
Country	:	US
Telephone Number	:	510-710-9333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ KEISA W SANDERS ” Practice Location

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