Healthcare Provider Details

I. General information

NPI: 1477494623
Provider Name (Legal Business Name): DAVID SANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000B S CENTER DR
CLEARLAKE CA
95422-8458
US

IV. Provider business mailing address

PO BOX 1578
CLEARLAKE OAKS CA
95423-1578
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-7090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: