Provider Demographics
NPI:1902907900
Name:BENDER, SANDRA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ANN
Last Name:BENDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43875 WASHINGTON ST STE E
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-8249
Mailing Address - Country:US
Mailing Address - Phone:760-565-6376
Mailing Address - Fax:760-565-6409
Practice Address - Street 1:43875 WASHINGTON ST STE E
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-8249
Practice Address - Country:US
Practice Address - Phone:760-565-6376
Practice Address - Fax:760-565-6409
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC56115207R00000X, 207RS0010X, 208000000X, 208000000X
IL036109652207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H78535Medicare UPIN