MEDICARE: STEVEN JAMES SANDERS PA-C

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
1	363AM0700X	Medical Physician Assistant	PA21125	CA

General Provider Information

NPI Number	:	1346556263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN JAMES SANDERS PA-C

Provider Business Mailing Address
First Line	:	17095 MAIN ST
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92345-0000
Country	:	US
Telephone Number	:	760-241-6666
Fax Number	:	760-956-4156

Provider Business Practice Location Address
First Line	:	1310 SAN BERNARDINO RD STE 105
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-4985
Country	:	US
Telephone Number	:	909-429-2864
Fax Number	:	909-429-2868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	03/04/2022

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