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General NPI Number Information
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NPI Number | 1265522528
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Entity Type | Individual
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Provider Name | RUSSELL LEONARD SANDBERG MD
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Gender | Male
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Dates
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Enumeration Date | 10/14/2006
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 1466 LINCOLN AVE
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2021
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Country | US
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Telephone | 415-457-3755
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Fax | 415-457-0849
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Provider Business Mailing Address
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Address Line | 433 THE ALAMEDA
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City | SAN ANSELMO
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State | CA
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Zip | 94960-1210
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Country | US
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Telephone | 415-456-1649
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Fax | 415-456-1649
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | G26538
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License Number State | CA
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