Healthcare Provider Details

I. General information

NPI: 1043214869
Provider Name (Legal Business Name): JENNIFER SANDERS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUSH ST STE 420
SAN FRANCISCO CA
94104-3907
US

IV. Provider business mailing address

100 BUSH ST STE 420
SAN FRANCISCO CA
94104-3907
US

V. Phone/Fax

Practice location:
  • Phone: 415-956-2884
  • Fax: 415-956-2662
Mailing address:
  • Phone: 415-956-2884
  • Fax: 415-956-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: