Healthcare Provider Details

I. General information

NPI: 1750392098
Provider Name (Legal Business Name): JAMES DANIEL SANDS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAN SANDS

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SEQUOIA CIR
SANTA ROSA CA
95401-4988
US

IV. Provider business mailing address

31 SEQUOIA CIRCLE
SANTA ROSA CA
95403
US

V. Phone/Fax

Practice location:
  • Phone: 707-237-1675
  • Fax: 707-581-2013
Mailing address:
  • Phone: 707-526-8306
  • Fax: 707-526-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12751
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12751
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY12751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: