=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477809515
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANDIA NATIONAL LABS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2012
-----------------------------------------------------
Last Update Date | 07/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7011 EAST AVE BUILDING 925
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-9610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-294-3501
-----------------------------------------------------
Fax | 925-294-2658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7011 EAST AVE BUILDING 925
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-9610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-294-3501
-----------------------------------------------------
Fax | 925-294-2658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | RICK SAUERMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 505-845-0145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QX0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------