Healthcare Provider Details

I. General information

NPI: 1225054596
Provider Name (Legal Business Name): SANJAYA SAXENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16880 W BERNARDO DR STE 160
SAN DIEGO CA
92127-1668
US

IV. Provider business mailing address

10275 MESA MADERA DR
SAN DIEGO CA
92131-1369
US

V. Phone/Fax

Practice location:
  • Phone: 310-367-0995
  • Fax:
Mailing address:
  • Phone: 310-367-0995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG73437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: