1235257338 NPI number — MR. HIROMI PAUL SANDERS MFT

Table of content: MR. HIROMI PAUL SANDERS MFT (NPI 1235257338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235257338 NPI number — MR. HIROMI PAUL SANDERS MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
HIROMI
Provider Middle Name:
PAUL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MFT
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:
1235257338
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6051 DUBLIN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CITRUS HEIGHTS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95610-6512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-727-4461
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11716 ENTERPRISE DRIVE
Provider Second Line Business Practice Location Address:
PLACER COUNTY CSOC
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-886-2811
Provider Business Practice Location Address Fax Number:
530-889-6735
Provider Enumeration Date:
03/27/2007

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: 106H00000X , with the licence number:  MFC34587 , 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)