Healthcare Provider Details

I. General information

NPI: 1952361412
Provider Name (Legal Business Name): RODERICK G S SANDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 MISSION AVE STE F
CARMICHAEL CA
95608-2955
US

IV. Provider business mailing address

3609 MISSION AVE STE F
CARMICHAEL CA
95608-2955
US

V. Phone/Fax

Practice location:
  • Phone: 916-484-4444
  • Fax: 916-484-4447
Mailing address:
  • Phone: 916-484-4444
  • Fax: 916-484-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberG42245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: