Healthcare Provider Details

I. General information

NPI: 1649413428
Provider Name (Legal Business Name): SANDRA KINDERMANN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DR MHSDS - R-2
VACAVILLE CA
95687
US

IV. Provider business mailing address

1600 CALIFORNIA DR MHSDS - R-2
VACAVILLE CA
95687
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 707-448-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY16696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: