Provider Demographics
NPI:1356849640
Name:SANDERLIN, DANA EVELYN
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:EVELYN
Last Name:SANDERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 1/2 KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2508
Mailing Address - Country:US
Mailing Address - Phone:909-239-6143
Mailing Address - Fax:
Practice Address - Street 1:625 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4321
Practice Address - Country:US
Practice Address - Phone:858-603-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician