Healthcare Provider Details

I. General information

NPI: 1487634515
Provider Name (Legal Business Name): PHILIP ALBERT SANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 STEVENS AVE STE 100
SOLANA BEACH CA
92075-2068
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-9800
  • Fax:
Mailing address:
  • Phone: 858-554-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA42137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: