Provider Demographics
NPI:1457667370
Name:SANDERS, VALERIE JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 CARNEGIE DR.,
Mailing Address - Street 2:STE. 230
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3583
Mailing Address - Country:US
Mailing Address - Phone:909-890-0407
Mailing Address - Fax:909-890-0575
Practice Address - Street 1:565 N. MT. VERNON AVE.
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-2661
Practice Address - Country:US
Practice Address - Phone:909-884-9091
Practice Address - Fax:909-373-7013
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11486OtherPA LICENSE