Provider Demographics
NPI:1043214869
Name:SANDERS, JENNIFER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BUSH ST
Mailing Address - Street 2:STE 420
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3907
Mailing Address - Country:US
Mailing Address - Phone:415-956-2884
Mailing Address - Fax:415-956-2662
Practice Address - Street 1:100 BUSH ST
Practice Address - Street 2:STE 420
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3907
Practice Address - Country:US
Practice Address - Phone:415-956-2884
Practice Address - Fax:415-956-2662
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3725213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU08681Medicare UPIN
CA000E37250Medicare ID - Type Unspecified
CA480013372Medicare PIN