Healthcare Provider Details

I. General information

NPI: 1184920407
Provider Name (Legal Business Name): JANIS K SANDLIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

PO BOX 7976
SAN DIEGO CA
92167-0976
US

V. Phone/Fax

Practice location:
  • Phone: 303-263-7919
  • Fax:
Mailing address:
  • Phone: 303-263-7919
  • Fax: 303-441-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52145
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0003373
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: