MEDICARE: SANFORD SELCON

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	207RG0100X	Gastroenterology Physician	C29359	CA

General Provider Information

NPI Number	:	1467883959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANFORD SELCON

Provider Business Mailing Address
First Line	:	8420 QUAIL OAKS DR
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6066
Country	:	US
Telephone Number	:	916-791-2895
Fax Number	:

Provider Business Practice Location Address
First Line	:	8420 QUAIL OAKS DR
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6066
Country	:	US
Telephone Number	:	916-791-2895
Fax Number	:

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

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/09/2013

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Directions to “ SANFORD SELCON ” Practice Location

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