Healthcare Provider Details

I. General information

NPI: 1962946442
Provider Name (Legal Business Name): ROBERT B. SANDERS D.O., A PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2016
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W MADISON AVE STE 2
EL CAJON CA
92020-3454
US

IV. Provider business mailing address

PO BOX 516529
LOS ANGELES CA
90051-0590
US

V. Phone/Fax

Practice location:
  • Phone: 619-334-7542
  • Fax: 619-938-2568
Mailing address:
  • Phone: 866-284-2771
  • Fax: 800-334-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A5544
License Number StateCA

VIII. Authorized Official

Name: ROBERT B. SANDERS
Title or Position: OWNER
Credential: D.O.
Phone: 619-922-4272