Healthcare Provider Details

I. General information

NPI: 1982158408
Provider Name (Legal Business Name): GEORGE SANFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 PLACER ST
REDDING CA
96001-1734
US

IV. Provider business mailing address

1915 PLACER ST
REDDING CA
96001-1734
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-2822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: