Provider Demographics
NPI:1093716847
Name:SANDERS, STEPHEN JEFFREY (AUD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JEFFREY
Last Name:SANDERS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26726 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6364
Mailing Address - Country:US
Mailing Address - Phone:949-364-4361
Mailing Address - Fax:949-364-7124
Practice Address - Street 1:26726 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6364
Practice Address - Country:US
Practice Address - Phone:949-364-4361
Practice Address - Fax:949-364-7124
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1156231H00000X
CAHA2517237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15940OtherGROUP PTAN
CAAS004ZOtherINDIVIDUAL PTAN
CAAS362ZOtherINDIVIDUAL PTAN
CAAU0011560OtherMEDI-CAL ID #
CAW8109OtherGROUP PTAN
CAW8109OtherGROUP PTAN