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NPI Code Detail

MEDICARE: STEPHANIE GONDRA-SANABRIA MD

MEDICARE: STEPHANIE GONDRA-SANABRIA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA166063IL

General Provider Information

NPI Number : 1114423266
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE GONDRA-SANABRIA MD
Provider Business Mailing Address
First Line : 24627 CANADA ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92354-2680
Country : US
Telephone Number : 702-224-4603
Fax Number :
Provider Business Practice Location Address
First Line : 1501 S CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1732
Country : US
Telephone Number : 773-542-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2018
Last Update Date : 01/12/2026

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