Provider Demographics
NPI:1043382856
Name:SANDSTROM, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SANDSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:ENGLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2000 OUTLET CENTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0607
Mailing Address - Country:US
Mailing Address - Phone:805-604-4588
Mailing Address - Fax:
Practice Address - Street 1:2000 OUTLET CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0607
Practice Address - Country:US
Practice Address - Phone:805-604-4588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA441622080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A441620Medicaid
CA00A441620Medicaid
00A441620Medicare ID - Type Unspecified