MEDICARE: JEANETTE SANDERS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1208085730	CA

General Provider Information

NPI Number	:	1871882399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE SANDERS

Provider Business Mailing Address
First Line	:	3756 SANTA ROSALIA DR STE 219
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3616
Country	:	US
Telephone Number	:	323-299-4357
Fax Number	:	323-299-1089

Provider Business Practice Location Address
First Line	:	3756 SANTA ROSALIA DR STE 219
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3616
Country	:	US
Telephone Number	:	323-299-4357
Fax Number	:	323-299-1089

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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Directions to “ JEANETTE SANDERS ” Practice Location

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