Healthcare Provider Details

I. General information

NPI: 1457364234
Provider Name (Legal Business Name): ANIKA L SANDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY FRONTAGE RD SUITE 216
MILL VALLEY CA
94941-3034
US

IV. Provider business mailing address

4 HAMILTON LNDG SUITE 100
NOVATO CA
94949-8256
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-3500
  • Fax: 415-383-3554
Mailing address:
  • Phone: 415-884-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA70742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: