Provider Demographics
NPI:1720360696
Name:PAHL, SANDRA ANNELIESE (MA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANNELIESE
Last Name:PAHL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 KETTNER BLVD APT 601
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2484
Mailing Address - Country:US
Mailing Address - Phone:512-744-7671
Mailing Address - Fax:
Practice Address - Street 1:2005 KNIGHT LANE BLDG H ATTN::MEDICAL STAFF SERVICE
Practice Address - Street 2:NAVY MEDICINE SUPPORT COMMAND
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:904-542-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program