Provider Demographics
NPI:1144264300
Name:SANDERS, ROBERT BRADLEY (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRADLEY
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W MADISON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3454
Mailing Address - Country:US
Mailing Address - Phone:619-334-7542
Mailing Address - Fax:619-938-2568
Practice Address - Street 1:161 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3909
Practice Address - Country:US
Practice Address - Phone:619-631-0128
Practice Address - Fax:619-631-0153
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A55442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE28290Medicare UPIN
CAW20A5544FMedicare PIN