1235102401 NPI number — MR. TERRY L SANDERFER M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235102401 NPI number — MR. TERRY L SANDERFER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERFER
Provider First Name:
TERRY
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235102401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 TOWN AND COUNTRY DR STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92860-3611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-808-6250
Provider Business Mailing Address Fax Number:
951-738-9954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 S MAIN ST STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92882-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-371-2703
Provider Business Practice Location Address Fax Number:
951-371-9348
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  G397360 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G397360 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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