Provider Demographics
NPI:1164464558
Name:SHORT-BARTLETT, SANDRA CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CHRISTINE
Last Name:SHORT-BARTLETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:CHRISTINE
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3440 E LA PALMA AVE
Mailing Address - Street 2:NEONATAL ICU
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2020
Mailing Address - Country:US
Mailing Address - Phone:714-644-7040
Mailing Address - Fax:714-644-7065
Practice Address - Street 1:3440 E LA PALMA AVE
Practice Address - Street 2:NEONATAL ICU
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2020
Practice Address - Country:US
Practice Address - Phone:714-644-7040
Practice Address - Fax:714-644-7065
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0431332080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0152464Medicaid