Provider Demographics
NPI:1033267240
Name:KAMIAK, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:KAMIAK
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 1:14583 BIG BASIN WAY
Mailing Address - Street 2:UNIT 3B
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6072
Mailing Address - Country:US
Mailing Address - Phone:408-741-1332
Mailing Address - Fax:408-741-5791
Practice Address - Street 1:14583 BIG BASIN WAY
Practice Address - Street 2:UNIT 3B
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6072
Practice Address - Country:US
Practice Address - Phone:408-741-1332
Practice Address - Fax:408-741-5791
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-37877207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG-37877OtherCA. PHYSICIAN LICENSE
CAG-37877OtherCA. PHYSICIAN LICENSE