MEDICARE: SANDRA STEDINGER MD INC

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	207N00000X	Dermatology Physician	G45094	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2488771	OTHER	CA	SECRETARY OF STATE CORP

General Provider Information

NPI Number	:	1699769067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA STEDINGER MD INC

Provider Business Mailing Address
First Line	:	3405 KENYON ST
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5003
Country	:	US
Telephone Number	:	619-226-3376
Fax Number	:	619-226-3370

Provider Business Practice Location Address
First Line	:	3405 KENYON ST
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5003
Country	:	US
Telephone Number	:	619-226-3376
Fax Number	:	619-226-3370

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANDRA L STEDINGER
Credential	:	MD
Telephone Number	:	619-226-3376

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/07/2023

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