Provider Demographics
NPI:1154201333
Name:SAMBITAN, MA DONNA
Entity type:Individual
Prefix:
First Name:MA DONNA
Middle Name:
Last Name:SAMBITAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 TICATICA DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-5438
Mailing Address - Country:US
Mailing Address - Phone:872-888-3892
Mailing Address - Fax:
Practice Address - Street 1:16666 E JOHNSON DR
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91745-2412
Practice Address - Country:US
Practice Address - Phone:626-820-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty