Healthcare Provider Details

I. General information

NPI: 1457483257
Provider Name (Legal Business Name): SANFORD SMALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 S SEPULVEDA BLVD
LOS ANGELES CA
90045-4008
US

IV. Provider business mailing address

8610 S SEPULVEDA BLVD
LOS ANGELES CA
90045-4008
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-1840
  • Fax: 310-670-4016
Mailing address:
  • Phone: 310-670-1840
  • Fax: 310-670-4016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA31969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: