Healthcare Provider Details

I. General information

NPI: 1285907717
Provider Name (Legal Business Name): MARY ANN SANDERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

331 SANTA ANA AVE
LONG BEACH CA
90803-1944
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5285
  • Fax:
Mailing address:
  • Phone: 562-433-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number288254
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: