Healthcare Provider Details

I. General information

NPI: 1346556263
Provider Name (Legal Business Name): STEVEN JAMES SANDERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SAN BERNARDINO RD STE 105
UPLAND CA
91786-4985
US

IV. Provider business mailing address

17095 MAIN ST
HESPERIA CA
92345-0000
US

V. Phone/Fax

Practice location:
  • Phone: 909-429-2864
  • Fax: 909-429-2868
Mailing address:
  • Phone: 760-241-6666
  • Fax: 760-956-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: