MEDICARE: DR. SANDRA ANN BENDER M.D.

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	207R00000X	Internal Medicine Physician	C56115	CA
2	207RS0010X	Sports Medicine (Internal Medicine) Physician	C56115	CA
3	208000000X	Pediatrics Physician	C56115	CA

General Provider Information

NPI Number	:	1902907900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA ANN BENDER M.D.

Provider Business Mailing Address
First Line	:	43875 WASHINGTON ST STE E
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-8249
Country	:	US
Telephone Number	:	760-565-6376
Fax Number	:	760-565-6409

Provider Business Practice Location Address
First Line	:	43875 WASHINGTON ST STE E
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-8249
Country	:	US
Telephone Number	:	760-565-6376
Fax Number	:	760-565-6409

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/17/2020

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