Healthcare Provider Details

I. General information

NPI: 1609870328
Provider Name (Legal Business Name): MAJA K SANDBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

963 BUTTE ST
REDDING CA
96001-0828
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS DEPT.
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-3921
  • Fax: 530-244-5639
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number21303
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC41523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: