Healthcare Provider Details

I. General information

NPI: 1740270313
Provider Name (Legal Business Name): JEFFREY A SANDLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 4TH AVE STE 340
SAN DIEGO CA
92103-2121
US

IV. Provider business mailing address

4060 4TH AVE STE 340
SAN DIEGO CA
92103-2121
US

V. Phone/Fax

Practice location:
  • Phone: 619-497-6188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG23440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: