1679693337 NPI number — MS. SANDRA L. LESSENDEN

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 1679693337 NPI number — MS. SANDRA L. LESSENDEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LESSENDEN
Provider First Name:
SANDRA
Provider Middle Name:
L.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
SANDRA
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFK
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679693337
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:
5877 CHABOT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94618-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-933-3338
Provider Business Mailing Address Fax Number:
510-654-3299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2940 CAMINO DIABLO
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94597-3987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-933-3338
Provider Business Practice Location Address Fax Number:
510-654-3299
Provider Enumeration Date:
03/29/2007

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:  MK24013 , 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)





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