Provider Demographics
NPI:1669650164
Name:BOSMAN, SANDRA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JEAN
Last Name:BOSMAN
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 1:100 WILLOW PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6206
Mailing Address - Country:US
Mailing Address - Phone:559-627-2719
Mailing Address - Fax:
Practice Address - Street 1:100 WILLOW PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6206
Practice Address - Country:US
Practice Address - Phone:559-627-2719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97989207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology