Healthcare Provider Details

I. General information

NPI: 1477640944
Provider Name (Legal Business Name): SANDRA DUNBRASKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 SW 4TH AVE SUITE 1
ONTARIO OR
97914
US

IV. Provider business mailing address

1219 SW 4TH AVE SUITE 1
ONTARIO OR
97914
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-2668
  • Fax: 541-889-2997
Mailing address:
  • Phone: 541-889-2668
  • Fax: 541-889-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD17772
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: