Provider Demographics
NPI:1609870328
Name:SANDBERG, MAJA K (MD)
Entity Type:Individual
Prefix:DR
First Name:MAJA
Middle Name:K
Last Name:SANDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:963 BUTTE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0828
Practice Address - Country:US
Practice Address - Phone:530-244-3921
Practice Address - Fax:530-244-5639
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-05-02
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
IA21303202K00000X
CAC41523208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609870328Medicaid
CAP01607851OtherRR MEDICARE
CA00C415230Medicaid
CA5950525OtherCIGNA
CA5950525OtherCIGNA
CA00C415231Medicare PIN
CACA186884Medicare PIN