Provider Demographics
NPI:1225117302
Name:SANDERS, DAVID H (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 SUNRISE AVENUE
Mailing Address - Street 2:SUITE # 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4528
Mailing Address - Country:US
Mailing Address - Phone:916-784-1244
Mailing Address - Fax:916-784-3949
Practice Address - Street 1:775 SUNRISE AVENUE
Practice Address - Street 2:SUITE # 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4528
Practice Address - Country:US
Practice Address - Phone:916-784-1244
Practice Address - Fax:916-784-3949
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6300103TC0700X
MI6301001098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY06300Medicaid
R27506Medicare UPIN
CAPSY06300Medicaid