Provider Demographics
NPI:1407980873
Name:DRESNIN, SANDOR GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDOR
Middle Name:GEORGE
Last Name:DRESNIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 LAS POSAS RD
Mailing Address - Street 2:SUITE #410
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3425
Mailing Address - Country:US
Mailing Address - Phone:818-883-3206
Mailing Address - Fax:
Practice Address - Street 1:2510 LAS POSAS RD
Practice Address - Street 2:SUITE #410
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3425
Practice Address - Country:US
Practice Address - Phone:818-883-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG152442084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE02596Medicare UPIN