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NPI Code Detail

MEDICARE: MS. DEBRA ANN SANDERSON RADI

MEDICARE:  MS. DEBRA ANN SANDERSON  RADI
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
1101YA0400XAddiction (Substance Use Disorder) Counselor18589406CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
118589406OTHERCACADC RADI

General Provider Information

NPI Number : 1700953932
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEBRA ANN SANDERSON RADI
Provider Business Mailing Address
First Line : 324 WEBSTER ST
Second Line : 1143 MISSOURI ST
City : FAIRFIELD
State : CA
Zip : 94533-6240
Country : US
Telephone Number : 707-435-9911
Fax Number : 707-435-0704
Provider Business Practice Location Address
First Line : 1143 MISSOURI ST
Second Line : 324 WEBSTER ST.
City : FAIRFIELD
State : CA
Zip : 94533-6007
Country : US
Telephone Number : 707-435-9911
Fax Number : 707-435-0704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 07/08/2007

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Directions to “ MS. DEBRA ANN SANDERSON RADI” Practice Location

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