Provider Demographics
NPI:1730453317
Name:GEORGE H. SANDERS
Entity type:Organization
Organization Name:GEORGE H. SANDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-981-3333
Mailing Address - Street 1:16633 VENTURA BLVD
Mailing Address - Street 2:110
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1801
Mailing Address - Country:US
Mailing Address - Phone:818-981-3333
Mailing Address - Fax:818-981-0249
Practice Address - Street 1:16633 VENTURA BLVD
Practice Address - Street 2:110
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1801
Practice Address - Country:US
Practice Address - Phone:818-981-3333
Practice Address - Fax:818-981-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42048208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48791Medicare UPIN