Healthcare Provider Details

I. General information

NPI: 1265984223
Provider Name (Legal Business Name): SANDRA BENDER M.D., A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77824 WILDCAT DR
PALM DESERT CA
92211-1134
US

IV. Provider business mailing address

77824 WILDCAT DR
PALM DESERT CA
92211-1134
US

V. Phone/Fax

Practice location:
  • Phone: 708-769-6581
  • Fax: 708-874-8284
Mailing address:
  • Phone: 708-769-6581
  • Fax: 708-874-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDRA ANN BENDER
Title or Position: OWNER, CEO
Credential: MD
Phone: 708-769-6581