Provider Demographics
NPI:1700862398
Name:MARTIN, SANDRA J (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:491 WYNDGATE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5939
Mailing Address - Country:US
Mailing Address - Phone:916-487-4270
Mailing Address - Fax:916-488-4360
Practice Address - Street 1:491 WYNDGATE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5939
Practice Address - Country:US
Practice Address - Phone:916-487-4270
Practice Address - Fax:916-488-4360
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2618213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery