Healthcare Provider Details

I. General information

NPI: 1902932726
Provider Name (Legal Business Name): KAREN LYNNE HORD-SANDQUIST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E FESLER ST
SANTA MARIA CA
93454-4404
US

IV. Provider business mailing address

115 E FESLER ST
SANTA MARIA CA
93454-4404
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-6597
  • Fax:
Mailing address:
  • Phone: 805-922-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberG86818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: